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Neonatal bilirubin binding capacity discerns risk of neurological dysfunction

Angelo A Lamola1, Vinod K Bhutani1, Lizhong Du2

  • 1Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, California.

Pediatric Research
|November 25, 2014
PubMed

Insights

Bilirubin binding capacity (BBC) assays in neonates offer a more robust method for assessing neurotoxicity risk than total bilirubin and gestational age alone. Individualized BBC testing can better predict infant tolerance to bilirubin loads.

Area of Science:

  • Neonatal Medicine
  • Biochemistry

Background:

  • Bilirubin binding capacity (BBC) reflects an infant's ability to handle free bilirubin.
  • BBC is distinct from albumin levels due to complex confounding factors.

Purpose of the Study:

  • To directly assay BBC in neonates using a modified hematofluorometric method.
  • To determine if BBC combined with total bilirubin (TB) can assess neurotoxicity risk.

Main Methods:

  • A novel hematofluorometric method was used to measure BBC in whole blood from neonates.
  • Data were combined with an archived database, and multiple regression modeling was applied.

Main Results:

  • Total bilirubin (TB) ranged from 0.7-22.8 mg/dl and BBC from 6.3-47.5 mg/dl.
  • Gestational age (GA) correlated with BBC (r = 0.54; P < 0.0002).
  • Recommended TB thresholds for treatment correspond to 45% and 67% of the observed BBC regression line.

Conclusions:

  • The variability in BBC levels suggests individualized assays are superior for gauging bilirubin neurotoxicity risk.
  • BBC offers a more robust assessment compared to TB and GA alone.
Abstract

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