Unbound bilirubin levels in phototherapy‐treated preterm infants receiving soy‐based lipid emulsion
Background Phototherapy is an effective treatment for neonatal jaundice. Treatment indication uses total serum bilirubin (TSB), although unbound bilirubin (Bf) more accurately predicts disability risk. The goals of this investigation were to examine the response of Bf and TSB to phototherapy in pret...
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| Veröffentlicht in: | Pediatrics international 2020-12, Vol.62 (12), p.1357-1363 |
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| creator | Hegyi, Thomas Kleinfeld, Alan Huber, Andrew Weinberger, Barry Memon, Naureen Carayannopoulos, Mary Oh, William |
| description | Background
Phototherapy is an effective treatment for neonatal jaundice. Treatment indication uses total serum bilirubin (TSB), although unbound bilirubin (Bf) more accurately predicts disability risk. The goals of this investigation were to examine the response of Bf and TSB to phototherapy in preterm infants, and we hypothesized that (i) TSB and Bf respond differently; (ii) the relationship between TSB and Bf is altered; and (iii) unexpected Bf elevations are found.
Methods
One hundred and seventeen preterm infants 17 nmol/L in 18, and >22 nmol/L in 7 infants.
Conclusions
Bf and TSB responded differently. While TSB and Bf correlated well before phototherapy, they did not correlate during phototherapy. TSB showed a trend toward a reduction with treatment, Bf did not. While TSB ROR information is not helpful, ROR Bf data can be utilized to anticipate treatment. Potentially high Bf levels existed before and after phototherapy and the mean Bf level at phototherapy termination remained elevated in a significant proportion of infants. |
| doi_str_mv | 10.1111/ped.14346 |
| format | Article |
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Phototherapy is an effective treatment for neonatal jaundice. Treatment indication uses total serum bilirubin (TSB), although unbound bilirubin (Bf) more accurately predicts disability risk. The goals of this investigation were to examine the response of Bf and TSB to phototherapy in preterm infants, and we hypothesized that (i) TSB and Bf respond differently; (ii) the relationship between TSB and Bf is altered; and (iii) unexpected Bf elevations are found.
Methods
One hundred and seventeen preterm infants <2 kg at birth and receiving (IL) were enrolled; and measurements of TSB and Bf were obtained. TSB was measured by the diazo method and Bf with a fluorescent Bf sensor BL22P1B11‐Rh.
Results
Initial mean (± SD) TSB and Bf levels (41.4 ± 6.9 h) were 8.0 ± 9.0 mg/dL and 16.9 ± 12.4 nmol/L (P < 0.05). The rates of rise (ROR) were 0.21 ± 0.10 mg/dL/h for TSB and 0.38 ± 0.33 nmol/L/h for Bf. Phototherapy reduced TSB from 8.0 ± 9.0 to 5.8 ± 9.4 mg/dL (P = 0.068) but Bf did not change (16.9 ± 12.4 to 14.1 ± 9.4 nmol/L P = n.s.). Bf levels were >11 nmol/L in 64, >17 nmol/L in 18, and >22 nmol/L in 7 infants.
Conclusions
Bf and TSB responded differently. While TSB and Bf correlated well before phototherapy, they did not correlate during phototherapy. TSB showed a trend toward a reduction with treatment, Bf did not. While TSB ROR information is not helpful, ROR Bf data can be utilized to anticipate treatment. Potentially high Bf levels existed before and after phototherapy and the mean Bf level at phototherapy termination remained elevated in a significant proportion of infants.</description><identifier>ISSN: 1328-8067</identifier><identifier>EISSN: 1442-200X</identifier><identifier>DOI: 10.1111/ped.14346</identifier><identifier>PMID: 32535983</identifier><language>eng</language><publisher>Australia: Blackwell Publishing Ltd</publisher><subject>Bilirubin ; Infants ; Jaundice ; Light therapy ; Neonates ; Newborn babies ; Pediatrics ; Phototherapy ; Premature babies ; premature infant ; total bilirubin ; unbound bilirubin</subject><ispartof>Pediatrics international, 2020-12, Vol.62 (12), p.1357-1363</ispartof><rights>2020 Japan Pediatric Society</rights><rights>2020 Japan Pediatric Society.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4436-5e80e7b9d4969e77f52afccf90ae0c4416cf2ddb35af0eac5ea841d73996b8433</citedby><cites>FETCH-LOGICAL-c4436-5e80e7b9d4969e77f52afccf90ae0c4416cf2ddb35af0eac5ea841d73996b8433</cites><orcidid>0000-0001-9919-1043</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fped.14346$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fped.14346$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32535983$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hegyi, Thomas</creatorcontrib><creatorcontrib>Kleinfeld, Alan</creatorcontrib><creatorcontrib>Huber, Andrew</creatorcontrib><creatorcontrib>Weinberger, Barry</creatorcontrib><creatorcontrib>Memon, Naureen</creatorcontrib><creatorcontrib>Carayannopoulos, Mary</creatorcontrib><creatorcontrib>Oh, William</creatorcontrib><title>Unbound bilirubin levels in phototherapy‐treated preterm infants receiving soy‐based lipid emulsion</title><title>Pediatrics international</title><addtitle>Pediatr Int</addtitle><description>Background
Phototherapy is an effective treatment for neonatal jaundice. Treatment indication uses total serum bilirubin (TSB), although unbound bilirubin (Bf) more accurately predicts disability risk. The goals of this investigation were to examine the response of Bf and TSB to phototherapy in preterm infants, and we hypothesized that (i) TSB and Bf respond differently; (ii) the relationship between TSB and Bf is altered; and (iii) unexpected Bf elevations are found.
Methods
One hundred and seventeen preterm infants <2 kg at birth and receiving (IL) were enrolled; and measurements of TSB and Bf were obtained. TSB was measured by the diazo method and Bf with a fluorescent Bf sensor BL22P1B11‐Rh.
Results
Initial mean (± SD) TSB and Bf levels (41.4 ± 6.9 h) were 8.0 ± 9.0 mg/dL and 16.9 ± 12.4 nmol/L (P < 0.05). The rates of rise (ROR) were 0.21 ± 0.10 mg/dL/h for TSB and 0.38 ± 0.33 nmol/L/h for Bf. Phototherapy reduced TSB from 8.0 ± 9.0 to 5.8 ± 9.4 mg/dL (P = 0.068) but Bf did not change (16.9 ± 12.4 to 14.1 ± 9.4 nmol/L P = n.s.). Bf levels were >11 nmol/L in 64, >17 nmol/L in 18, and >22 nmol/L in 7 infants.
Conclusions
Bf and TSB responded differently. While TSB and Bf correlated well before phototherapy, they did not correlate during phototherapy. TSB showed a trend toward a reduction with treatment, Bf did not. While TSB ROR information is not helpful, ROR Bf data can be utilized to anticipate treatment. Potentially high Bf levels existed before and after phototherapy and the mean Bf level at phototherapy termination remained elevated in a significant proportion of infants.</description><subject>Bilirubin</subject><subject>Infants</subject><subject>Jaundice</subject><subject>Light therapy</subject><subject>Neonates</subject><subject>Newborn babies</subject><subject>Pediatrics</subject><subject>Phototherapy</subject><subject>Premature babies</subject><subject>premature infant</subject><subject>total bilirubin</subject><subject>unbound bilirubin</subject><issn>1328-8067</issn><issn>1442-200X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNp10E9LwzAYBvAgipvTg19ACl700C1p0jY9ypx_QNCDA28lbd9uGWlTk3aymx_Bz-gnMbPbRfC95CX8eHh5EDoneEzcTBooxoRRFh2gIWEs8AOM3w7dTgPucxzFA3Ri7QpjzGPOjtGABiENE06HaDGvM93VhZdJJU2XydpTsAZlPbc1S93qdglGNJvvz6_WgGih8BoDLZjKiVLUrfUM5CDXsl54Vm9dJqxTSjay8KDqlJW6PkVHpVAWznbvCM3vZq_TB__p-f5xevPk54zRyA-BY4izpGBJlEAcl2EgyjwvEywAO0KivAyKIqOhKDGIPATBGSlimiRRxhmlI3TV5zZGv3dg27SSNgelRA26s2nACMOYBIw7evmHrnRnanedUzGJnUm26rpXudHWGijTxshKmE1KcLptP3Xtp7_tO3uxS-yyyv3u5b5uByY9-JAKNv8npS-z2z7yB7cOkj8</recordid><startdate>202012</startdate><enddate>202012</enddate><creator>Hegyi, Thomas</creator><creator>Kleinfeld, Alan</creator><creator>Huber, Andrew</creator><creator>Weinberger, Barry</creator><creator>Memon, Naureen</creator><creator>Carayannopoulos, Mary</creator><creator>Oh, William</creator><general>Blackwell Publishing Ltd</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TK</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-9919-1043</orcidid></search><sort><creationdate>202012</creationdate><title>Unbound bilirubin levels in phototherapy‐treated preterm infants receiving soy‐based lipid emulsion</title><author>Hegyi, Thomas ; Kleinfeld, Alan ; Huber, Andrew ; Weinberger, Barry ; Memon, Naureen ; Carayannopoulos, Mary ; Oh, William</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4436-5e80e7b9d4969e77f52afccf90ae0c4416cf2ddb35af0eac5ea841d73996b8433</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Bilirubin</topic><topic>Infants</topic><topic>Jaundice</topic><topic>Light therapy</topic><topic>Neonates</topic><topic>Newborn babies</topic><topic>Pediatrics</topic><topic>Phototherapy</topic><topic>Premature babies</topic><topic>premature infant</topic><topic>total bilirubin</topic><topic>unbound bilirubin</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hegyi, Thomas</creatorcontrib><creatorcontrib>Kleinfeld, Alan</creatorcontrib><creatorcontrib>Huber, Andrew</creatorcontrib><creatorcontrib>Weinberger, Barry</creatorcontrib><creatorcontrib>Memon, Naureen</creatorcontrib><creatorcontrib>Carayannopoulos, Mary</creatorcontrib><creatorcontrib>Oh, William</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Neurosciences Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Pediatrics international</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hegyi, Thomas</au><au>Kleinfeld, Alan</au><au>Huber, Andrew</au><au>Weinberger, Barry</au><au>Memon, Naureen</au><au>Carayannopoulos, Mary</au><au>Oh, William</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Unbound bilirubin levels in phototherapy‐treated preterm infants receiving soy‐based lipid emulsion</atitle><jtitle>Pediatrics international</jtitle><addtitle>Pediatr Int</addtitle><date>2020-12</date><risdate>2020</risdate><volume>62</volume><issue>12</issue><spage>1357</spage><epage>1363</epage><pages>1357-1363</pages><issn>1328-8067</issn><eissn>1442-200X</eissn><abstract>Background
Phototherapy is an effective treatment for neonatal jaundice. Treatment indication uses total serum bilirubin (TSB), although unbound bilirubin (Bf) more accurately predicts disability risk. The goals of this investigation were to examine the response of Bf and TSB to phototherapy in preterm infants, and we hypothesized that (i) TSB and Bf respond differently; (ii) the relationship between TSB and Bf is altered; and (iii) unexpected Bf elevations are found.
Methods
One hundred and seventeen preterm infants <2 kg at birth and receiving (IL) were enrolled; and measurements of TSB and Bf were obtained. TSB was measured by the diazo method and Bf with a fluorescent Bf sensor BL22P1B11‐Rh.
Results
Initial mean (± SD) TSB and Bf levels (41.4 ± 6.9 h) were 8.0 ± 9.0 mg/dL and 16.9 ± 12.4 nmol/L (P < 0.05). The rates of rise (ROR) were 0.21 ± 0.10 mg/dL/h for TSB and 0.38 ± 0.33 nmol/L/h for Bf. Phototherapy reduced TSB from 8.0 ± 9.0 to 5.8 ± 9.4 mg/dL (P = 0.068) but Bf did not change (16.9 ± 12.4 to 14.1 ± 9.4 nmol/L P = n.s.). Bf levels were >11 nmol/L in 64, >17 nmol/L in 18, and >22 nmol/L in 7 infants.
Conclusions
Bf and TSB responded differently. While TSB and Bf correlated well before phototherapy, they did not correlate during phototherapy. TSB showed a trend toward a reduction with treatment, Bf did not. While TSB ROR information is not helpful, ROR Bf data can be utilized to anticipate treatment. Potentially high Bf levels existed before and after phototherapy and the mean Bf level at phototherapy termination remained elevated in a significant proportion of infants.</abstract><cop>Australia</cop><pub>Blackwell Publishing Ltd</pub><pmid>32535983</pmid><doi>10.1111/ped.14346</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0001-9919-1043</orcidid></addata></record> |
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| subjects | Bilirubin Infants Jaundice Light therapy Neonates Newborn babies Pediatrics Phototherapy Premature babies premature infant total bilirubin unbound bilirubin |
| title | Unbound bilirubin levels in phototherapy‐treated preterm infants receiving soy‐based lipid emulsion |
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