Bronze baby syndrome and the risk of kernicterus

Abstract

The possible strategies for implementing an approach to the management of hyperbilirubinemia (especially the haemolytic kind) in the presence of BBS may include an exchange transfusion carried out at lower TSB concentration than previously recommended or an early administration of Sn-mesoporphyrin.

Pulse oximetry interference in bronze baby syndrome

“…[5][6][7] Copper (II) porphyrins found in the plasma and tissues of infants with BBS, in the presence of bilirubin, are susceptible to phototherapy (blue light)-induced photodestruction, resulting in brown photoproducts. 5,6,8 Such brown pigments, in which structure has yet to be delineated, are thought to be responsible for the bronze discoloration seen in BBS. They have spectral characteristics that resemble those isolated in the sera of infants with BBS, which show a generalized absorption in the near ultraviolet and red spectral regions.…”

An approach to the management of hyperbilirubinemia in the preterm infant less than 35 weeks of gestation

“…49,50 There is some evidence that elevated direct bilirubin levels can decrease the infant's albumin-binding capacity 51 and it has been suggested, but not confirmed, that infants with the bronze baby syndrome might be at an increased risk of developing bilirubin encephalopathy. 51,52 As a general rule, when considering the use of phototherapy or exchange transfusion, the direct-reacting (or conjugated) bilirubin level should not be subtracted from the total. Infants with conjugated bilirubin levels >50% of the TSB require individual expert evaluation.…”

The side effects of phototherapy for neonatal jaundice: what do we know? What should we do?

“…It is generally believed that BBS is harmless, and pigmentation returns slowly to normal if NNPT is discontinued [65]. However, BBS may constitute an additional risk for developing kernicterus [21]. Thus, neonates with a mixed (direct-indirect) hyperbilirubinemia undergoing NNPT should be closely investigated for underlying BBS.…”

“…Bronze baby syndrome [33,95] Case report 4 [21,77] Case series 4 Asthma [9,10] Case-control study 3b Allergic rhinitis and conjunctivitis [40] Case-control study 3b Melanotic nevus and skin cancers [81] Case report 4 [20,29,31,63] Case-control study 3b [25] Cohort study 2b Patent ductus arteriosus [14,19,98] Before-after study 2c [15,58] Cohort study 2b [76] RCT 1b Retinopathy of prematurity [101] Case-control study 3b [37,52] Cohort study 2b [39] Cross-sectional study 4 for NNPT is to use it only when really needed, considering risks and benefits, and following the officially available guidelines. Current guidelines for NNPT issued by the American Academy of Pediatrics (AAP) are widely accepted in clinical practice.…”