Bilirubin Displacing Effect of Drugs Used in Neonatology

Robertson, Alex; Karp, Warren B.; Brodersen, Rolf

doi:10.1111/j.1651-2227.1991.tb11798.x

Cited by 53 publications

(25 citation statements)

References 29 publications

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“…As the brain-to-serum ratio bilirubin in ceftriaxone-treated animals increased relatively more than in former studies on mdr1-null mutant mice devoid of P-gp (11), the bilirubin-displacing property of the drug apparently had an additive impact on bilirubin entry into brain. However, pretreatment with agents without a significant bilirubin-displacing effect increased bilirubin accumulation in whole brain by 24% (erythromycin, NS) to 66% (rifampin) (34). This increase corresponds to the increase in brain bilirubin induced by other known risk factors such as hyperosmolarity or hypercapnia.…”

Section: Discussionmentioning

confidence: 89%

Administration of Drugs Known to Inhibit P-Glycoprotein Increases Brain Bilirubin and Alters the Regional Distribution of Bilirubin in Rat Brain

et al. 2003

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Section: Discussionmentioning

confidence: 89%

Administration of Drugs Known to Inhibit P-Glycoprotein Increases Brain Bilirubin and Alters the Regional Distribution of Bilirubin in Rat Brain

et al. 2003

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“…High free fatty acid levels may have contributed to an impediment of bilirubin binding in our patients but were not measured. Potential displacing drugs 41 given to our preterm infants, such as indomethacin, penicillin, and furosemide, normally do not achieve serum levels sufficient to displace significant amounts of unconjugated bilirubin, but their combined effect is unknown. Ahlfors 7 lined up arguments for the use of serum bilirubin/albumin molar ratio as an acceptable surrogate for determination of residual binding capacity of albumin or of free serum bilirubin levels.…”

Section: Discussionmentioning

confidence: 99%

Changes in Globus Pallidus With (Pre)Term Kernicterus

et al. 2003

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ABSTRACT. Objective. We report serial magnetic resonance (MR) and sonographic behavior of globus pallidus in 5 preterm and 3 term infants with kernicterus and describe the clinical context in very low birth weight preterm infants. On the basis of this information, we suggest means of diagnosis and prevention.Methods. Charts and MR and ultrasound images of 5 preterm infants and 3 term infants with suspected bilirubin-associated brain damage were reviewed. Included were preterm infants with severe hearing loss, quadriplegic hypertonia, and abnormal hypersignal of globus pallidus on T2-weighted MR imaging (MRI). In 1 infant who died on day 150, the diagnosis was confirmed during the neonatal period. The others were picked up as outpatients and scanned at 12 or 22 months' corrected age. Three instances of term kernicterus were included for comparison of serial MRI in the neonatal period and early infancy: they were caused by glucose-6-phosphate dehydrogenase deficiency, urosepsis, and dehydration plus fructose 1-6 biphosphatase deficiency.Results. Five preterm infants of 25 to 29 weeks' gestational age presented with total serum bilirubin (TSB) levels below exchange transfusion thresholds commonly advised. Mixed acidosis was present in 3 infants around the TSB peak. The bilirubin/albumin molar ratio was >0.5 in all, in the absence of displacing drugs. All failed to pass bedside hearing screen tests and had severe hearing loss on auditory brain response testing. Symmetrical homogeneous hyperechogenicity of globus pallidus was the alerting feature in 1 infant. Globus pallidus was hyperintense on T1-weighted MR images in this child. The other infants presented with severe developmental delay as a result of dyskinetic quadriplegia and hearing loss. Globus pallidus was normal on T1-but hyperintense on T2-weighted MR images at 12 or 22 months' corrected age. Subthalamic involvement was documented in coronal fluid attenuated inversion recovery MRI in 2 infants. The term infants with classical clinical presentation in the neonatal period had MR behavior similar to the preterms, but pallidal injury was not recognized with targeted sonographic examination. Their

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“…Prenatal care and delivery in a tertiary care centre, with facilities for rapid bilirubin and albumin assays and phototherapy for mother and infant 6. Avoidance of drugs that increase unbound, unconjugated bilirubin (Robertson et al 1991;Strauss et al 2006) 7. Neurological testing of the child after birth and during early childhood Features of pregnancies in patients with Crigler-Najjar reported in the literature, PT phototherapy, Phb phenobarbital, CS caesarean sections, NA not available, CB cord blood, D1 blood taken on first day after delivery.…”

Section: Discussionmentioning

confidence: 99%

Recommendations for Pregnancies in Patients with Crigler-Najjar Syndrome

et al. 2012

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During pregnancy, the developing foetus in mothers with Crigler-Najjar type 1 and 2 is exposed to raised levels of unconjugated bilirubin, with the risk of neurotoxicity. We describe two pregnancies in a patient with Crigler-Najjar type 2, who was carefully monitored prior to and during pregnancy and phototherapy adjusted to maintain serum bilirubin levels below 200 mmol/l and the bilirubin/albumin molar ratio below 50%. Both pregnancies resulted in normal delivery of healthy infants who had normal neurological development. A review of all reported pregnancies in Crigler-Najjar patients and a set of recommendations are presented.

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Bilirubin Displacing Effect of Drugs Used in Neonatology

Cited by 53 publications

References 29 publications

Administration of Drugs Known to Inhibit P-Glycoprotein Increases Brain Bilirubin and Alters the Regional Distribution of Bilirubin in Rat Brain

Administration of Drugs Known to Inhibit P-Glycoprotein Increases Brain Bilirubin and Alters the Regional Distribution of Bilirubin in Rat Brain

Changes in Globus Pallidus With (Pre)Term Kernicterus

Recommendations for Pregnancies in Patients with Crigler-Najjar Syndrome

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