Published online November 1, 2006
PEDIATRICS Vol. 118 No. 5 November 2006, pp. 2265 (doi:10.1542/peds.2006-2346)
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LETTER TO THE EDITOR

Prenatal Exposure to Conjugated Bilirubin

Francesco Raimondi, MD
Letizia Capasso, MD
Fiorella Migliaro, MD
Antonia Romano, MD
Roberto Paludetto, MD
Division of Neonatology
Department of Pediatrics
Università "Federico II"
80131 Naples, Italy

To the Editor.—

Although the hazards related to postnatal hyperbilirubinemia are well described,1 less is known about prenatal exposure to high concentrations of bilirubin, particularly in its conjugated form. This issue was raised while we were anticipating the birth of an infant to a mother affected by end-stage bile duct adenocarcinoma. She had developed chronic bilirubin concentrations up to 26 mg/dL, almost entirely in its direct form. She delivered a 33-week, 2440-g, appropriate-for-gestational-age male infant with a negligible serum bilirubin level at birth despite the intense yellow staining of the cord, the amniotic fluid, and the vernix. Later, the neonate developed common unconjugated hyperbilirubinemia treated briefly with phototherapy and was discharged without significant problems. We believe that this rare, but not exceptional, situation underlines the clinical importance of the placenta as an efficient barrier to the maternal-fetal transfer of conjugated bilirubin.

REFERENCE

  1. Wennberg RP, Ahlfors CE, Bhutani VK, Johnson LH, Shapiro SM. Toward understanding kernicterus: a challenge to improve the management of jaundiced newborns [published correction appears in Pediatrics. 2006;117:1467]. Pediatrics. 2006;117 :474 –485[Abstract/Free Full Text]
PEDIATRICS (ISSN 1098-4275). ©2006 by the American Academy of Pediatrics

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