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Factors Affecting the Relationship Between Total and Unbound Bilirubin in Preterm and Term Infants

Thomas Hegyi1, Dalya Chefitz1, Alan Weller1

  • 1Division of Neonatology, Department of Pediatrics, Robert Wood Johnson Medical School, Rutgers, the State University of New Jersey, New Brunswick, New Jersey, USA.

Acta Paediatrica (Oslo, Norway : 1992)
|March 22, 2025
PubMed

Insights

The ratio of unbound bilirubin (Bf) to total serum bilirubin (TSB) is higher in preterm infants and those requiring phototherapy. This ratio helps predict bilirubin toxicity risk in newborns.

Area of Science:

  • Neonatal Medicine
  • Pediatric Biochemistry

Background:

  • Neonatal jaundice is common, but high levels can cause neurological damage.
  • Unbound bilirubin (Bf) is a key indicator of bilirubin toxicity.
  • Understanding the relationship between Bf and total serum bilirubin (TSB) is crucial for risk assessment.

Purpose of the Study:

  • To investigate the relationship between TSB and Bf in newborn infants.
  • To identify factors influencing this relationship, including prematurity, feeding method, and phototherapy.

Main Methods:

  • A ratio (R = Bf/TSB × 10⁶) was developed to compare Bf and TSB concentrations.
  • TSB and Bf measurements were simultaneously collected from term and preterm infants.
  • The influence of prematurity, hemolysis, feeding type, and phototherapy on the R-value was analyzed.

Main Results:

  • The study included 170 term and 130 preterm infants.
  • The mean R-value was significantly higher in preterm infants (15.18) compared to term infants (3.64).
  • Prematurity and high TSB requiring phototherapy were associated with increased R-values, particularly at toxic Bf levels.

Conclusions:

  • The R-value effectively reflects the relationship between Bf and TSB.
  • Higher R-values indicate increased risk, especially in preterm infants and those with severe jaundice requiring phototherapy.
  • This ratio can aid in predicting and managing bilirubin toxicity in neonates.
Abstract

Keywords:
hyperbilirubinemianewbornunbound bilirubin

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