The classical controlled clinical trial reported by Mollison and Walker (8) and subsequent clinical experience has established exchange transfusion as the standard treatment for preventing bilirubin encephalopathy
in severe neonatal hyperbilirubinemia.
England (2010) highlights that unbound unconjugated bilirubin (not attached to albumin) coupled with other risk factors, such as pre-term birth and low levels or lack of oxygen, may open up the blood-brain barrier, enabling the unconjugated bilirubin to enter the brain resulting in bilirubin encephalopathy
In 2004, AAP issued a clinical practice guideline focused on reducing the frequency of severe hyperbilirubinemia and bilirubin encephalopathy
This is the first time that the Task Force has addressed chronic bilirubin encephalopathy
, a rare neurologic condition that affects roughly less than 1 infant per 100,000 live births.
The evidence supports using risk factor assessment or hour-specific bilirubin measurement to identify infants at risk for hyperbilirubinemia, but not all infants with chronic bilirubin encephalopathy
have a history of hyperbilirubinemia, the task force wrote.
They also have an increased risk of bilirubin encephalopathy
, especially if they've been breast fed.
In addition, incidence of acute bilirubin encephalopathy
and kernicterus have increased among otherwise healthy breastfed infants with poor feeding and delayed follow up visits (AAP, 2004; Harris et al.
Although kernicterus, or bilirubin encephalopathy
, is preventable, it is still occurring.
In otherwise well babies the risk of exchange transfusion are usually small but in preterm babies who are unwell the risks of exchange transfusion are increased and the procedure must be balanced the high morbidity associated with bilirubin encephalopathy
The letter cites in vitro studies that have shown that ceftriaxone "can displace bilirubin from its binding to serum albumin," which can result in bilirubin encephalopathy
in this population.
Unconjugated bilirubin that is left untreated, however, may lead to bilirubin encephalopathy
(also called kernicterus), which is a condition of severe brain damage that results from unconjugated bilirubin crossing the blood-brain barrier and depositing into neurons (Hazinski, 1999).
Concern of pediatrician regarding the early discharge is bilirubin encephalopathy
sequel occurring in healthy term infants even without hemolysis.