Bilirubin binding in jaundiced newborns: from bench to bedside?

Background: Bilirubin-induced neurologic dysfunction (BIND) is a spectrum of preventable neurological sequelae in jaundiced newborns. Current total plasma bilirubin ( B T ) concentration thresholds for phototherapy and/or exchange transfusion poorly predict BIND. Methods: The unbound (free) bilirubin ( B f ) measured at these B T thresholds provides additional information about the risk for BIND. B f can be readily adapted to clinical use by determining B f population parameters at current B T thresholds. These parameters can be established using a plasma bilirubin binding panel (BBP) consisting of B T , B f , and two empiric constants, the maximum B T ( B Tmax ) and the corresponding equilibrium association bilirubin constant (K). Results: B Tmax and K provide the variables needed to accurately estimate B f at B T