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Toward understanding kernicterus: a challenge to improve the management of jaundiced newborns.
Pediatrics. 2006 Feb; 117(2):474-85.Ped

Abstract

PURPOSE

We sought to evaluate the sensitivity and specificity of total serum bilirubin concentration (TSB) and free (unbound) bilirubin concentration (Bf) as predictors of risk for bilirubin toxicity and kernicterus and to examine consistency between these findings and proposed mechanisms of bilirubin transport and brain uptake.

METHODS

A review of literature was undertaken to define basic principles of bilirubin transport and brain uptake leading to neurotoxicity. We then reviewed experimental and clinical evidence that relate TSB or Bf to risk for bilirubin toxicity and kernicterus.

RESULTS

There are insufficient published data to precisely define sensitivity and specificity of either TSB or Bf in determining risk for acute bilirubin neurotoxicity or chronic sequelae (kernicterus). However, available laboratory and clinical evidence indicate that Bf is better than TSB in discriminating risk for bilirubin toxicity in patients with severe hyperbilirubinemia. These findings are consistent with basic pharmacokinetic principles involved in bilirubin transport and tissue uptake.

CONCLUSIONS

Experimental and clinical data strongly suggest that measurement of Bf in newborns with hyperbilirubinemia will improve risk assessment for neurotoxicity, which emphasizes the need for additional clinical evaluation relating Bf and TSB to acute bilirubin toxicity and long-term outcome. We speculate that establishing risk thresholds for neurotoxicity by using newer methods for measuring Bf in minimally diluted serum samples will improve the sensitivity and specificity of serum indicators for treating hyperbilirubinemia, thus reducing unnecessary aggressive intervention and associated cost and morbidity.

Authors+Show Affiliations

Division of Neonatology, Department of Pediatrics, University of Washington, Box 356320, Seattle, WA 98195, USA. rpwennberg@hotmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

16452368

Citation

Wennberg, Richard P., et al. "Toward Understanding Kernicterus: a Challenge to Improve the Management of Jaundiced Newborns." Pediatrics, vol. 117, no. 2, 2006, pp. 474-85.
Wennberg RP, Ahlfors CE, Bhutani VK, et al. Toward understanding kernicterus: a challenge to improve the management of jaundiced newborns. Pediatrics. 2006;117(2):474-85.
Wennberg, R. P., Ahlfors, C. E., Bhutani, V. K., Johnson, L. H., & Shapiro, S. M. (2006). Toward understanding kernicterus: a challenge to improve the management of jaundiced newborns. Pediatrics, 117(2), 474-85.
Wennberg RP, et al. Toward Understanding Kernicterus: a Challenge to Improve the Management of Jaundiced Newborns. Pediatrics. 2006;117(2):474-85. PubMed PMID: 16452368.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Toward understanding kernicterus: a challenge to improve the management of jaundiced newborns. AU - Wennberg,Richard P, AU - Ahlfors,Charles E, AU - Bhutani,Vinod K, AU - Johnson,Lois H, AU - Shapiro,Steven M, PY - 2006/2/3/pubmed PY - 2006/2/28/medline PY - 2006/2/3/entrez SP - 474 EP - 85 JF - Pediatrics JO - Pediatrics VL - 117 IS - 2 N2 - PURPOSE: We sought to evaluate the sensitivity and specificity of total serum bilirubin concentration (TSB) and free (unbound) bilirubin concentration (Bf) as predictors of risk for bilirubin toxicity and kernicterus and to examine consistency between these findings and proposed mechanisms of bilirubin transport and brain uptake. METHODS: A review of literature was undertaken to define basic principles of bilirubin transport and brain uptake leading to neurotoxicity. We then reviewed experimental and clinical evidence that relate TSB or Bf to risk for bilirubin toxicity and kernicterus. RESULTS: There are insufficient published data to precisely define sensitivity and specificity of either TSB or Bf in determining risk for acute bilirubin neurotoxicity or chronic sequelae (kernicterus). However, available laboratory and clinical evidence indicate that Bf is better than TSB in discriminating risk for bilirubin toxicity in patients with severe hyperbilirubinemia. These findings are consistent with basic pharmacokinetic principles involved in bilirubin transport and tissue uptake. CONCLUSIONS: Experimental and clinical data strongly suggest that measurement of Bf in newborns with hyperbilirubinemia will improve risk assessment for neurotoxicity, which emphasizes the need for additional clinical evaluation relating Bf and TSB to acute bilirubin toxicity and long-term outcome. We speculate that establishing risk thresholds for neurotoxicity by using newer methods for measuring Bf in minimally diluted serum samples will improve the sensitivity and specificity of serum indicators for treating hyperbilirubinemia, thus reducing unnecessary aggressive intervention and associated cost and morbidity. SN - 1098-4275 UR - https://wwww.unboundmedicine.com/medline/citation/16452368/Toward_understanding_kernicterus:_a_challenge_to_improve_the_management_of_jaundiced_newborns_ L2 - http://pediatrics.aappublications.org/cgi/pmidlookup?view=long&pmid=16452368 DB - PRIME DP - Unbound Medicine ER -