EXPERIENCE AND REASON |
Department of Pediatrics
California Pacific Medical Center
San Francisco, California 94118
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Abbreviations: K, equilibrium association binding constant ABR, auditory brainstem response G6PD, glucose-6-phosphate dehydrogenase
| The first 300 words of the full text of this article appear below. |
| INTRODUCTION |
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1 and 1.5 µg/dL (.017-.026 µmol/L).2,3 In term newborns, however, unbound bilirubin levels between .9 and 2 µg/dL, which would be associated kernicterus in premature newborns, produce only subtle, reversible changes in ABR wave latency and amplitude.4 Although the unbound bilirubin levels associated with kernicterus in term newborns are unknown, they clearly are greater than the levels associated with kernicterus in premature infants. This indicates that, as with the total bilirubin and total bilirubin/albumin ratio, the unbound bilirubin levels associated with kernicterus increase as birth weight and gestation increase.1,5
We have been using a Food & Drug Administration-approved method6 for measuring unbound bilirubin in jaundiced newborns as an adjunct to their clinical care since 1998. We use a weight-based unbound bilirubin reference value of 1.3 µg/dL/kg (the level of unbound bilirubin at which exchange transfusion should be considered) up to a maximum of 4 µg/dL to accommodate the need to increase the reference unbound bilirubin as birth weight increases and to incorporate the solubility limits of unbound bilirubin at ph 7.4 (
4 µg/dL) into the reference criteria.15,79
We recently encountered a term, jaundiced newborn that developed acute shock and died, apparently from kernicterus. This report describes the infants clinical course and bilirubin-albumin binding data. This case provides insight into the levels of unbound bilirubin associated with kernicterus in term infants as well as the acute changes in distribution of the bilirubin load (miscible bilirubin pool) between the tissues and the vascular space following the onset of kernicterus.
| CASE REPORT |
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Reprint requests to (C.E.A.) Division of Neonatology, Department of Pediatrics, California Pacific Medical Center, 3850 California St, San Francisco, CA 94118. E-mail: ligand@centurytel.net
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