PEDIATRICS Vol. 81 No. 2 February 1988, pp. 304-315
This Article
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Perlman, M.
Right arrow Articles by Frank, J. W.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Perlman, M.
Right arrow Articles by Frank, J. W.

Bilirubin Beyond the Blood-Brain Barrier

Max Perlman MB, BS, FRCP(Lond), FRCP(C)1 and John W. Frank MD, CCFP, MSc, FRCP(C)1

1 From the Division of Neonatology, Department of Pediatrics, and Department of Preventive Medicine and Biostatistics, University of Toronto, Toronto

We evaluated the utility of recording neural signals, such as auditory brainstem responses, as potential new criteria for treatment of neonatal jaundice. Findings from recent studies of auditory brainstem responses and behavior of jaundiced infants reinforce the notion that asymptomatic and even symptomatic neurotoxicity caused by bilirubin may occur relatively frequently at relatively low serum bilirubin concentrations. Evidence suggests that this is transient and reversible. Whereas current criteria for the prevention of kernicterus are based on the idea that bilirubin entry to the CNS should be averted, the existence of transient subclinical and clinical bilirubin-induced neurotoxicity suggests that the focus of prevention might be shifted to events beyond the bloodbrain barrier. With the use of "finer tools" to detect neurotoxicity, it may be possible to recognize a prior stage of neurotoxicity, described here as "transient subclinical bilirubin-induced neurotoxicity." Recordings of neural signals might be used as either predictors of kernicterus or as immediately available "outcomes" or end points with which biochemical predictors (serum bilirubin and "unbound" bilirubin concentrations) might be correlated, to determine their relative value as predictors of entry of bilirubin to the CNS. It is suggested that the results of studies to determine the relative risks associated with the various predictive criteria, namely, a prospective cohort analysis, may not be available for many years and that randomized controlled trials of new criteria for exchange transfusion are even further removed from reality.

Key Words: bilirubin • blood-brain barrier • central nervous system • kernicterus

Submitted on December 17, 1986
Accepted on August 11, 1987




This article has been cited by other articles:


Home page
 J Child NeurolHome page
Y. Yilmaz, S. Degirmenci, F. Akdas, S. Kulekci, A. Ciprut, S. Yuksel, F. Yildiz, L. Karadeniz, and A. Say
Prognostic Value of Auditory Brainstem Response for Neurologic Outcome in Patients With Neonatal Indirect Hyperbilirubinemia
J Child Neurol, October 1, 2001; 16(10): 772 - 775.
[Abstract] [PDF]