Neonatal Jaundice in Preterm Infants with Bilirubin Encephalopathy

Abstract

Introduction: The aim of this study is to clarify bilirubin parameters and its treatment in preterm infants with bilirubin encephalopathy (pBE). Methods: We asked the responders to an earlier nationwide Japanese survey on pBE to provide additional information. pBE was diagnosed based on the criteria used in the nationwide survey. We collected data on serum total bilirubin (TB), direct bilirubin (DB), albumin, and unbound bilirubin (UB) levels during the first 8 weeks of life, and on phototherapy and exchange transfusion treatments. Results: We obtained clinical data from 75 patients with pBE from 58 hospitals (response rate of 59%), who were born between 2002 and 2016. The average peak TB level was 12.6 mg/dL (215 μmol/L), and the average age at peak attainment was 19.7 days after birth. Albumin level was <2.5 g/dL in 44 patients, and the peak DB level was ≥2 mg/dL (34.2 μmol/L) in 20 patients. The average peak bilirubin/albumin (B/A) (mg/g) ratio was 3.8 (molar ratio of 0.475), and the average age at peak attainment was 18.6 days. The average peak UB level was 0.67 μg/dL (11.5 nmol/L). The median duration of phototherapy was 6 days, and the median day of the last session was 12. The peak TB level occurred after the last day of phototherapy in 30 of the 61 patients available for comparison. Conclusions: Most patients with pBE lacked marked elevations in serum TB levels and the B/A ratio, the peaks of which were sometimes delayed to >4 weeks after birth.

Risk factors for neonatal hyperbilirubinemia: a systematic review and meta-analysis

“…Hyperbilirubinemia is the most common cause of neonatal hospitalization (1), and although most newborns with hyperbilirubinemia have a good prognosis (2), approximately 8-11% maintain a high bilirubin level, which may lead to severe complications, including lifelong disability such as growth retardation, encephalopathy, autism and hearing impairment (3)(4)(5). The incidence of pathological jaundice is 1% without risk factors of hyperbilirubinemia, whereas it is 59% with risk factors (3).…”

Encephalitis Associated With SARS-CoV-2 Infection in a Child With Chiari Malformation Type I

“…During the first 11 days of hospitalization, the patient had low globulin and higher albumin/globulin ratio, associated with brain structure, function, and perfusion (21). The liver function tests could have suggested neurological damage by SARS-CoV-2, including higher levels of bilirubin (direct and indirect) (22) determined during the first six days of hospitalization. The possible routes of SARS-CoV-2 entry to the CNS are 1) via the ACE-2 on endothelial cells of the blood-cerebrospinal fluid barrier or 2) via retrograde axonal transport of peripheral neural pathways such as via the olfactory mucosa through TLR4 and neuropilin 1 (4,5,12,23).…”

Evaluation of the Quality of Perinatal Trials: Making the GRADE

“…For example, trials of interventions to prevent bilirubin encephalopathy and kernicterus spectrum disorder have tended to report the effect on serum bilirubin levels rather than on adverse neurodevelopmental outcomes [30]. While this may be a pragmatic approach given the rarity of kernicterus spectrum disorder, particularly in countries with well-resourced perinatal health services, evidence exists that even very plausible surrogate outcomes such as hyperbilirubinaemia may not necessarily predict infant-important outcomes accurately [31, 32].…”