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Background: Measured unbound bilirubin concentration is influenced by bilirubin photoisomers. Bilirubin photoisomers are produced even with only a slight light exposure, and clinical samples are inevitably exposed to light. The objective of the study was to evaluate the influence of bilirubin photoisomers on the measurement of unbound bilirubin using serum of jaundiced neonates during blue light phototherapy. Methods: Five neonates treated with phototherapy for hyperbilirubinaemia were enrolled. The samples were taken 12 h after initiation of phototherapy. Samples were processed by irradiation with blue light, by indoor ceiling light, by both blue light and indoor ceiling light or shaded. Bilirubin subfractions, total bilirubin and unbound bilirubin were measured. Results: Compared with the non-irradiated samples, the (EZ)-cyclobilirubin concentration and (ZE)-bilirubin/(ZZ)-bilirubin ratio significantly increased in the blue light-irradiated samples, the (ZE)-bilirubin/(ZZ)-bilirubin ratio significantly increased in the indoor ceiling light-irradiated samples, and the (EZ)-cyclobilirubin, (EZ)-bilirubin and (ZE)-bilirubin/(ZZ)-bilirubin ratiosignificantly increased in the samples irradiated with both lights. No change was noted in unbound bilirubin in any group. Conclusions: We consider that changes in bilirubin photoisomers induced by light exposure during clinical practice do not influence the measured unbound bilirubin concentration.

Sporadic hemiplegic migraine is rare in childhood. We followed a patient with Tc-ECD (Tc-ethyl cysteinate dimer) SPECT and magnetic resonance angiography (MRA). At the age of 8 years, he developed left hemiplegia. The MRA showed vasoconstriction of the posterior right middle cerebral artery. Hemiplegia disappeared in a few hours, and the MRA normalized. At the age of 10 years, right hemiplegia was observed, disappearing completely after a few days. During this second migraine attack, MRA demonstrated left middle cerebral artery vasoconstriction, and SPECT revealed decreased left hemisphere blood flow. Findings normalized as the patient recovered.

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