Bronze baby syndrome, an unpredictable complication of phototherapy: A case report

Abstract

The bronze baby syndrome is an infrequent dyschromia resulting from phototherapy in newborn babies with neonatal jaundice. Even though the common phenotype has been described in patients with direct neonatal hyperbilirubinemia secondary to cholestasis, several cases of patients with indirect neonatal hyperbilirubinemia who have managed to reverse it have been reported, as well as patients with isolated hyperbilirubinemia.Currently, the physiopathology of this condition is still a subject of controversy and, therefore, there is a lack of clear conducts for its correct diagnosis and treatment.Generally, this syndrome has been considered as a mild condition that is resolved with the suspension of phototherapy. Its duration is usually not greater than the neonatal period, and it has no long-term sequelae. However, its occurrence is considered an absolute contraindication for the continuation of phototherapy. In case of persistence, the recommendation is to decrease bilirrubin levels and proceed with exchange transfusion; this procedure, however, represents risks for the newborn, so our recommendation is to suspend phototherapy and reinitiate it if the direct bilirrubin value decreases, andcholestasis compromise has been discarded. Serial evaluations of acute encephalopathy caused by bilirrubin are absolutely recommended.The objective of this paper was to describe the case of a newborn with ABO incompatibility who developed the bronze baby syndrome. This patient responded satisfactorily to the suspension and resumption of phototherapy without exchange transfusion.

Bronzed baby with low peripheral saturation: Is it real?

“…Despite BBS being considered a self‐limiting process, there is no consensus on when to start and stop phototherapy treatment. Although some authors have recommended stopping phototherapy, 3 most of them suggest continuing phototherapy to decrease bilirubin levels and reduce the risk of exchange transfusion 4 …”

Brief Report: Bronzed baby with low peripheral saturation. Is it real?

“…This can be explained by bilirubin's spectral absorbance, which does not extend to wavelengths of 500nm. 1 On the other hand, Bronze baby syndrome (BBS) is an unusual condition developed in neonates with elevated serum levels of unconjugated and conjugated bilirubin treated with phototherapy [2][3][4] . Although the exact etiology of BBS is still unknown, there are possible explanations about why bronze skin colour may occurs.…”

“…8 Despite BBS is considered a self-limiting process there is not consensus on stopping or not phototherapy treatment. Although some authors have recommended stopping phototherapy 3 , most of them recommend continuing phototherapy to decrease bilirubin levels and so the risk of exchange transfusion 4 .…”

Gray-brown skin discoloration following phototherapy for hyperbilirubinemia due to anti-E alloimmunization

“…Le and Reese [3] suggested that development of BBS should not lead to suspension of the use of phototherapy for hyperbilirubinemia in infants with elevated conjugated bilirubin levels. Conversely, Peinado-Acevedo et al [10] stated that the continuation of phototherapy presented a risk of cholestasis to newborns with BBS and recommended that it be suspended; however, phototherapy can be reinitiated when the direct bilirubin level decreases and cholestasis has resolved. It is not clear whether phototherapy should be continued or stopped in BBS.…”