Department of Pediatrics, Robert Wood Johnson Medical School, Rutgers, The State University of NJ, New Brunswick, NJ, USA.
Fluoresprobe Sciences, San Diego, CA, USA.
J Matern Fetal Neonatal Med. 2022 Apr;35(8):1532-1538. doi: 10.1080/14767058.2020.1761318. Epub 2020 May 4.
Hyperbilirubinemia occurs in over 80% of newborns, and severe bilirubin toxicity can lead to neurological dysfunction and death. Unbound bilirubin (Bf) levels predict the risk of neurodevelopmental handicap, although total serum bilirubin (TSB) is used to manage care.
To measure Bf levels in healthy infants, its relationship to TSB, and its response to phototherapy. We hypothesize unexpectedly high Bf levels, poor correlation with TSB and unpredictable response to phototherapy.
DESIGN/METHODS: Healthy infants were studied with simultaneous TSB and Bf measurements. The clinical data recorded included ethnicity, gender, birth weight, gestational age, and mode of delivery, Apgar scores, breast/formula feeds, and phototherapy.
One hundred thirty-two infants (3248.9 ± 509.2g, GA 38.7 ± 1.4 weeks), at mean age of the initial sample of 28.5 ± 15.6 h, had a TSB of 7.9 ± 2.7 mg/dl, and a Bf of 5.2 ± 3.2 nM. The correlation between Bf and TSB was significant but not between Bf and TSB for TSB >12 mg/dl. Bf >11nm were in 22.7% and >17 nM in 3.8% of infants. Post-phototherapy TSB and Bf levels were similar to those before treatment.
The relationship between TSB and Bf in healthy infants is complex, with the inability of one to predict the other's level in infants with elevated TSB. The mechanism of bilirubin-related neurotoxicity suggests that the management of jaundice in healthy infants requires Bf measurements. Management of jaundice with TSB may result in more infants exposed to phototherapy. However, unexpected elevations of Bf occur in an apparently healthy population.
高胆红素血症在超过 80%的新生儿中发生，严重的胆红素毒性可导致神经功能障碍和死亡。未结合胆红素（Bf）水平可预测神经发育障碍的风险，尽管总血清胆红素（TSB）用于管理护理。
测量健康婴儿的 Bf 水平，研究其与 TSB 的关系以及光疗的反应。我们假设 Bf 水平异常高，与 TSB 相关性差，且对光疗反应不可预测。
设计/方法：同时测量健康婴儿的 TSB 和 Bf。记录的临床数据包括种族、性别、出生体重、胎龄和分娩方式、阿普加评分、母乳喂养/配方奶喂养以及光疗。
132 名婴儿（3248.9±509.2g，GA 38.7±1.4 周），初始样本的平均年龄为 28.5±15.6h，TSB 为 7.9±2.7mg/dl，Bf 为 5.2±3.2nM。Bf 与 TSB 之间存在显著相关性，但 TSB>12mg/dl 时 Bf 与 TSB 之间无相关性。Bf>11nm 的婴儿占 22.7%，Bf>17nM 的婴儿占 3.8%。光疗后 TSB 和 Bf 水平与治疗前相似。
健康婴儿 TSB 和 Bf 之间的关系复杂，在 TSB 升高的婴儿中，一种方法无法预测另一种方法的水平。胆红素相关神经毒性的机制表明，健康婴儿黄疸的管理需要测量 Bf。使用 TSB 管理黄疸可能会导致更多婴儿接受光疗。然而，在看似健康的人群中，Bf 水平会意外升高。
