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Bilirubin-albumin binding and free bilirubin
1Division of Neonatology, Department of Pediatrics, California Pacific Medical Center, 3850 California Street, San Francisco, CA 94118, USA.
Insights
Measuring free bilirubin is crucial for understanding neonatal jaundice and preventing toxicity. Reliable methods exist, but population reference values are needed for clinical application.
Area of Science:
- Neonatal Medicine
- Biochemistry
Background:
- The role of plasma bilirubin-albumin binding in neonatal jaundice and toxicity remains debated.
- Free bilirubin concentration is a key factor in neonatal hyperbilirubinemia.
Purpose of the Study:
- To evaluate the significance of free bilirubin in neonatal jaundice and toxicity.
- To support the clinical measurement of free bilirubin in jaundiced newborns.
Main Methods:
- Assessing the role of free bilirubin in toxicity induced by sulfisoxazole or benzyl alcohol.
- Correlating free bilirubin levels with auditory brainstem response changes.
Main Results:
- Free bilirubin plays a pivotal role in neonatal bilirubin toxicity.
- Free bilirubin levels correlate with bilirubin-induced auditory brainstem response alterations.
Conclusions:
- Measuring free bilirubin is strongly supported for evaluating neonatal jaundice.
- Available methods for free bilirubin measurement need population reference values for clinical utility.
Abstract:
The relevance of plasma bilirubin-albumin binding and, in particular, the nonalbumin-bound or "free" bilirubin concentration to neonatal bilirubin toxicity is controversial. The pivotal role that "free" bilirubin played in the bilirubin toxicity that occurred following administration of sulfisoxazole or benzyl alcohol to jaundiced newborns, and the correlation of "free" bilirubin with bilirubin-induced changes in the auditory brainstem response are strong support for measuring "free" bilirubin when evaluating neonatal jaundice. Reliable methods for measuring "free bilirubin" are available, and population reference values are needed to help determine its proper clinical use.