Preterm neonates remain at increased risk for adverse bilirubin-related outcomes, including acute bilirubin encephalopathy relative to term infants. Yet, most vulnerable neonates are likely to benefit from the potent anti-oxidant properties of bilirubin. Evidence-based guidelines for the management of hyperbilirubinemia in preterm infants, however, are lacking. High concentrations of unconjugated bilirubin can cause permanent neurologic damage in infants, evident through magnetic resonance imaging of chronic bilirubin encephalopathy or kernicterus. There is a growing concern that exposures to even moderate concentrations of bilirubin may lead to subtle but permanent neurodevelopmental impairment referred to as bilirubin-induced neurologic dysfunction. Our current use of phototherapy to decrease bilirubin loads and its potential photo-oxidant properties is a biological conundrum that has been questioned in the use of phototherapy for very low birth weight neonates. In this issue of Clinics in Perinatology, we provide updates on the current understanding of the biology, mechanisms of increasing bilirubin load due to hemolysis, decreased bilirubin binding capacity and glucose-6-phosphate dehydrogenase deficiency, as well as clinical strategies to operationalize the thresholds for hyperbilirubinemia interventions in preterm infants.
1. Cover image - p. 1 2. Title page - p. 2 3. Table of Contents - p. 3 4. Copyright - p. 4 5. Contributors - p. 5 6. CME Accreditation Page - p. 6 7. Forthcoming Issues - p. 7 8. Foreword: Why the Premature Brain Is More Prone to Bilirubin-induced Injury - p. 8 9. Preface: Preterm Neonates: Beyond the Guidelines for Neonatal Hyperbilirubinemia - p. 9 10. Hyperbilirubinemia in Preterm Neonates - p. 10 11. Hemolysis in Preterm Neonates - p. 21 12. Bilirubin Binding Capacity in the Preterm Neonate - p. 25 13. A Pharmacologic View of Phototherapy - p. 36 14. Biology of Bilirubin Photoisomers - p. 46 15. Phototherapy and the Risk of Photo-Oxidative Injury in Extremely Low Birth Weight Infants - p. 54 16. Bilirubin-Induced Neurotoxicity in the Preterm Neonate - p. 57 17. Bilirubin-Induced Audiologic Injury in Preterm Infants - p. 66 18. The Preterm Infant - p. 73 19. Glucose-6-Phosphate Dehydrogenase Deficiency and the Need for a Novel Treatment to Prevent Kernicterus - p. 82 20. Cholestasis in Preterm Infants - p. 90 21. Development of a Web-Based Decision Support Tool to Operationalize and Optimize Management of Hyperbilirubinemia in Preterm Infants - p. 101 22. Index - p. 104
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Preterm neonates remain at increased risk for adverse bilirubin-related outcomes, including acute bilirubin encephalopathy relative to term infants. Yet, most vulnerable neonates are likely to benefit from the potent anti-oxidant properties of bilirubin. Evidence-based guidelines for the management of hyperbilirubinemia in preterm infants, however, are lacking. High concentrations of unconjugated bilirubin can cause permanent neurologic damage in infants, evident through magnetic resonance imaging of chronic bilirubin encephalopathy or kernicterus. There is a growing concern that exposures to even moderate concentrations of bilirubin may lead to subtle but permanent neurodevelopmental impairment referred to as bilirubin-induced neurologic dysfunction. Our current use of phototherapy to decrease bilirubin loads and its potential photo-oxidant properties is a biological conundrum that has been questioned in the use of phototherapy for very low birth weight neonates. In this issue of Clinics in Perinatology, we provide updates on the current understanding of the biology, mechanisms of increasing bilirubin load due to hemolysis, decreased bilirubin binding capacity and glucose-6-phosphate dehydrogenase deficiency, as well as clinical strategies to operationalize the thresholds for hyperbilirubinemia interventions in preterm infants.
1. Cover image - p. 1 2. Title page - p. 2 3. Table of Contents - p. 3 4. Copyright - p. 4 5. Contributors - p. 5 6. CME Accreditation Page - p. 6 7. Forthcoming Issues - p. 7 8. Foreword: Why the Premature Brain Is More Prone to Bilirubin-induced Injury - p. 8 9. Preface: Preterm Neonates: Beyond the Guidelines for Neonatal Hyperbilirubinemia - p. 9 10. Hyperbilirubinemia in Preterm Neonates - p. 10 11. Hemolysis in Preterm Neonates - p. 21 12. Bilirubin Binding Capacity in the Preterm Neonate - p. 25 13. A Pharmacologic View of Phototherapy - p. 36 14. Biology of Bilirubin Photoisomers - p. 46 15. Phototherapy and the Risk of Photo-Oxidative Injury in Extremely Low Birth Weight Infants - p. 54 16. Bilirubin-Induced Neurotoxicity in the Preterm Neonate - p. 57 17. Bilirubin-Induced Audiologic Injury in Preterm Infants - p. 66 18. The Preterm Infant - p. 73 19. Glucose-6-Phosphate Dehydrogenase Deficiency and the Need for a Novel Treatment to Prevent Kernicterus - p. 82 20. Cholestasis in Preterm Infants - p. 90 21. Development of a Web-Based Decision Support Tool to Operationalize and Optimize Management of Hyperbilirubinemia in Preterm Infants - p. 101 22. Index - p. 104
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