Serum bilirubin and bilirubin/ albumin ratio as predictors of bilirubin encephalopathy
Because a reliable test to identify all newborns at risk for developing acute bilirubin encephalopathy
is not available (United States Preventive Services Task Force, 2009), the AAP (2004) supports an approach that attempts to balance the risks between failure to identify possible risks of hyperbilirubinemia and those associated with overtreatment.
We know that neonatal hyperbilirubinemia is a medical emergency, because unconjugated bilirubin is neurotoxic in certain concentration and under various conditions and may cause bilirubin encephalopathy
Acute bilirubin encephalopathy
and kernicterus are known to be the two major complications associated with it, resulting in neurotoxic effects, including sensorineural hearing loss, hypotonia, delayed motor skills and intellectual deficits.
However, if serum bilirubin levels exceed a dangerous limit, which varies with birth weight, gestational age, chronological age and internal milieu of the body, bilirubin may cross blood brain barrier and bilirubin encephalopathy
This technique shows positive effects in more than 200 medical conditions among which Ataxia, Alzheimer's Disease, Autism, Cerebral palsy, Adrenoleukodystrophy, many types of Epilepsy, color blindness, Macular Degeneration, Retinitis Pigmentosa, Cone-Rod Dystrophy, Vascular Dementia, Leukoencephalopathy, Huntington's disease, Multiple Sclerosis, Parkinson's Disease, Stroke, Bilirubin encephalopathy
to name a few.
Ostrow, "The molecular basis of bilirubin encephalopathy
and toxicity: report of an EASL Single Topic Conference, Trieste, Italy, 1-2 October, 2004," Journal of Hepatology, vol.
If the concentration of non-conjugated bilirubin in the blood is too high, it breaches the blood brain barrier and bilirubin encephalopathy
occurs with serious consequences for the child.
Alex and Gallant (2008) reinforce that as long as the baby is thriving and other pathologies have been ruled out, breast milk jaundice is not known to result in bilirubin encephalopathy
. NICE (2010) has specifically recommended research on the link between breastfeeding and jaundice so there may be developments in the evidence available in the near future.
HLCs can also be given before the onset of bilirubin encephalopathy
occurs, and can thus provide sufficient amounts of UGT1A1 to allow the liver to metabolize this toxin.
Factors that alter these parameters increase the risk for developing hyperbilirubinaemia and acute bilirubin encephalopathy
They address genetics, biochemistry, transport, metabolism of bilirubin, the physiology and epidemiology of neonatal hyperbilirubinemia, public policy measures, clinical management, and interventions for the prevention and treatment of hyperbilirubinemia and bilirubin encephalopathy
in low and middle-income countries.