Division of Neonatology, Department of Pediatrics, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, N.J., USA.
Neonatology. 2013;104(3):184-7. doi: 10.1159/000349995. Epub 2013 Aug 17.
Extremely low birth weight (ELBW; <1,000 g) infants have poor outcomes, often compromised by bilirubin neurotoxicity. We measured unbound bilirubin (Bf) and unbound free fatty acid (FFAu) levels in 5 ELBW infants in a trial examining the effects of pharmacologic ductal closure on infants treated with Intralipid infusion (3 g/kg/day). The levels for all infants (mean ± SD) were: total serum bilirubin (TSB) 4.6 ± 1.7 mg/dl, FFAu 376 ± 496 nM, and Bf 42 ± 30 nM. Of the 3 infants who died, 2 had TSB <5.9 mg/dl but FFAu >580 nM and Bf >75 nM. Multiple regression revealed a major effect on Bf levels due to FFAu, indicating that Intralipid elevated levels of FFAu and Bf. Indomethacin or ibuprofen reduced Bf levels, most likely by reducing FFAu levels through lipase inhibition. Because displacement of Bf by FFAu decouples Bf from TSB, phototherapy may not reduce the risk of bilirubin or FFAu toxicity in Intralipid-treated ELBW infants.
极低出生体重（ELBW；<1000g）婴儿的预后较差，常因胆红素神经毒性而受损。我们在一项研究中测量了 5 名 ELBW 婴儿的未结合胆红素（Bf）和未结合游离脂肪酸（FFAu）水平，该研究旨在检查药物性胆管闭锁对接受脂肪乳输注（3g/kg/天）治疗的婴儿的影响。所有婴儿的水平（平均值±标准差）如下：总血清胆红素（TSB）4.6±1.7mg/dl，FFAu376±496nM，Bf42±30nM。在死亡的 3 名婴儿中，有 2 名 TSB<5.9mg/dl，但 FFAu>580nM 和 Bf>75nM。多元回归显示，FFAu 对 Bf 水平有主要影响，表明脂肪乳升高了 FFAu 和 Bf 水平。吲哚美辛或布洛芬降低了 Bf 水平，这很可能是通过脂肪酶抑制降低了 FFAu 水平。由于 FFAu 取代了 Bf，使 Bf 与 TSB 分离，因此光疗可能不会降低脂肪乳治疗的 ELBW 婴儿胆红素或 FFAu 毒性的风险。
