Unbound bilirubin associated with kernicterus: A historical approach - 05/09/11
Abstract |
Objective: To determine the unbound bilirubin concentration (UBC) associated with kernicterus with the use of clinical data from clusters of kernicterus after sulfisoxazole and benzyl alcohol administration. Design: Sulfisoxazole at 12 mg/dL and benzoate at 10 mmol/L are associated with kernicterus at total bilirubins near 12 and 10 mg/dL, respectively. The concurrent UBC was estimated by first measuring the drug-induced increases in UBC in plasma and artificial sera (peroxidase-diazo method). The increases were then applied to baseline UBC, determined by linear regression analysis of binding data (peroxidase method) from 86 newborns, at total bilirubins of 12 mg/dL for sulfisoxazole and 10 mg/dL for benzoate. Sensitivity and specificity were determined with existing data. Results: Sulfisoxazole and benzoate increased UBC in artificial sera 2.1-fold and 4.1-fold, respectively, and in plasma (sulfisoxazole) 2.4-fold. Benzoate would increase baseline UBC from 0.29 to 1.19 μg/dL and sulfisoxazole from 0.36 to 0.86 μg/dL. The sensitivity and specificity of a UBC of 0.86 μg/dL for predicting kernicterus are 79% and 92% and for 1.19 μg/dL, 50% and 98%, respectively. Conclusion: Historic data predict that the unbound bilirubin above which kernicterus becomes likely lies between 0.86 and 1.19 μg/dL, in good agreement with existing information. (J Pediatr 2000;137:540-4)
Le texte complet de cet article est disponible en PDF.Abbreviations : ABR, Kp, TBC, UBC
Plan
Supported in part by a Scientist Support Grant from the California Pacific Medical Center Research Institute. |
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Reprint requests: Charles E. Ahlfors, MD, California Pacific Medical Center, Department of Pediatrics, Division of Neonatology, 3850 California St, San Francisco, CA 94118. |
Vol 137 - N° 4
P. 540-544 - octobre 2000 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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