Akihisa Okumura1, Shintaro Ichimura2, Masahiro Hayakawa3, Hiroshi Arai4, Yoshihiro Maruo5, Takashi Kusaka6, Tetsuya Kunikata7, Satoko Kumada8, Ichiro Morioka9. 1. Department of Pediatrics, Aichi Medical University, Nagakute, Japan, okumura.akihisa.479@mail.aichi-med-u.ac.jp. 2. Department of Perinatal and Neonatal Medicine, Aichi Medical University, Nagakute, Japan. 3. Division of Neonatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan. 4. Department of Pediatric Neurology, Bobath Memorial Hospital, Osaka, Japan. 5. Department of Pediatrics, Shiga University of Medical Science, Otsu, Japan. 6. Department of Pediatrics, Faculty of Medicine, Kagawa University, Takamatsu, Japan. 7. Division of Neonatal Medicine, Department of Pediatrics, Saitama Medical University Hospital, Iruma-Gun, Saitama, Japan. 8. Department of Neuropediatrics, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan. 9. Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan.
Abstract
INTRODUCTION: The aim of this study is to clarify bilirubin parameters and its treatment in preterm infants with bilirubin encephalopathy (pBE). METHODS: We asked the responders to an earlier nationwide Japanese survey on pBE to provide additional information. pBE was diagnosed based on the criteria used in the nationwide survey. We collected data on serum total bilirubin (TB), direct bilirubin (DB), albumin, and unbound bilirubin (UB) levels during the first 8 weeks of life, and on phototherapy and exchange transfusion treatments. RESULTS: We obtained clinical data from 75 patients with pBE from 58 hospitals (response rate of 59%), who were born between 2002 and 2016. The average peak TB level was 12.6 mg/dL (215 μmol/L), and the average age at peak attainment was 19.7 days after birth. Albumin level was <2.5 g/dL in 44 patients, and the peak DB level was ≥2 mg/dL (34.2 μmol/L) in 20 patients. The average peak bilirubin/albumin (B/A) (mg/g) ratio was 3.8 (molar ratio of 0.475), and the average age at peak attainment was 18.6 days. The average peak UB level was 0.67 μg/dL (11.5 nmol/L). The median duration of phototherapy was 6 days, and the median day of the last session was 12. The peak TB level occurred after the last day of phototherapy in 30 of the 61 patients available for comparison. CONCLUSIONS: Most patients with pBE lacked marked elevations in serum TB levels and the B/A ratio, the peaks of which were sometimes delayed to >4 weeks after birth.
INTRODUCTION: The aim of this study is to clarify bilirubin parameters and its treatment in preterm infants with bilirubinencephalopathy (pBE). METHODS: We asked the responders to an earlier nationwide Japanese survey on pBE to provide additional information. pBE was diagnosed based on the criteria used in the nationwide survey. We collected data on serum total bilirubin (TB), direct bilirubin (DB), albumin, and unbound bilirubin (UB) levels during the first 8 weeks of life, and on phototherapy and exchange transfusion treatments. RESULTS: We obtained clinical data from 75 patients with pBE from 58 hospitals (response rate of 59%), who were born between 2002 and 2016. The average peak TB level was 12.6 mg/dL (215 μmol/L), and the average age at peak attainment was 19.7 days after birth. Albumin level was <2.5 g/dL in 44 patients, and the peak DB level was ≥2 mg/dL (34.2 μmol/L) in 20 patients. The average peak bilirubin/albumin (B/A) (mg/g) ratio was 3.8 (molar ratio of 0.475), and the average age at peak attainment was 18.6 days. The average peak UB level was 0.67 μg/dL (11.5 nmol/L). The median duration of phototherapy was 6 days, and the median day of the last session was 12. The peak TB level occurred after the last day of phototherapy in 30 of the 61 patients available for comparison. CONCLUSIONS: Most patients with pBE lacked marked elevations in serum TB levels and the B/A ratio, the peaks of which were sometimes delayed to >4 weeks after birth.