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Factors Determining δ-Bilirubin Levels in Infants With Biliary Atresia

Wen Ye1, Philip Rosenthal, John C Magee

  • 1*Department of Biostatistics, University of Michigan, Ann Arbor †Departments of Pediatrics & Surgery, UCSF Benioff Children's Hospital, University of California, San Francisco ‡Department of Surgery, University of Michigan, Ann Arbor §Department of Pediatrics, Feinberg Medical School of Northwestern University, Ann & Robert H. Lurie Children's Hospital of Chicago, IL.

Journal of Pediatric Gastroenterology and Nutrition
|January 8, 2015
PubMed

Insights

Serum delta-bilirubin (Bδ) levels in infants with biliary atresia increase with conjugated bilirubin (Bc) and prolonged cholestasis. This finding aids in diagnosing and managing cholestasis in infants.

Area of Science:

  • Biochemistry
  • Pediatric Gastroenterology
  • Neonatology

Background:

  • Delta-bilirubin (Bδ) is formed via nonenzymatic transesterification of bilirubin conjugates with albumin in cholestasis.
  • Infants with biliary atresia, a form of neonatal cholestasis, exhibit detectable Bδ levels.

Purpose of the Study:

  • To investigate factors influencing serum Bδ concentrations in infants diagnosed with biliary atresia.
  • To establish correlations between Bδ levels and other bilirubin analytes and cholestasis duration.

Main Methods:

  • Prospective study (PROBE) enrollment of infants with biliary atresia.
  • Analysis of concurrently measured serum bilirubin analytes: total bilirubin (TB), conjugated bilirubin (Bc), and unconjugated bilirubin.
  • Application of graphical methods and a linear mixed-effects model to assess Bδ variability.

Main Results:

  • Serum Bδ levels demonstrated a positive correlation with increasing conjugated bilirubin (Bc) and total bilirubin (TB).
  • The duration of cholestasis was a significant determinant of Bδ levels, with each 100-day increase associated with a 1.0 mg/dL rise in Bδ (P < 0.0001).
  • Serum albumin levels did not show a significant association with Bδ concentrations (P = 0.89).

Conclusions:

  • Elevated Bδ levels in infants with biliary atresia are linked to higher Bc concentrations and longer cholestasis duration.
  • Understanding the interrelationships between Bδ, Bc, TB, and direct-reacting bilirubin aids in assessing cholestasis severity.
  • This knowledge supports improved diagnosis and clinical management strategies for infants and children with biliary atresia.
Abstract

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