Bronze Baby Syndrome

Gray-brown skin discoloration following phototherapy for hyperbilirubinemia due to anti-E alloimmunization

“…BBS, an unusual neonatal dyschromia, develops in jaundiced neonates following phototherapy and is characterized by a diffuse gray-brown pigmentation of the skin [1-3]. Bronze baby syndrome (BBS) is a rare condition that develops only in infants with elevated serum conjugated and unconjugated bilirubin levels; however, in BBS, conjugated bilirubin level is not always elevated [4].…”

“…Pigmentation can develop in various abdominal organs and body fluids, but the risk of kernicterus and central nervous system staining is controversial. [3] BBS should be differentiated from gray baby syndrome, which is exclusively observed in neonates and young infants receiving high doses of chloramphenicol [4]. BBS must also be differentiated from dusky-hued neonates with cyanosis.…”

“…An abnormal accumulation of the photoisomers of bilirubin may cause BBS [3]. The second suggested cause is the abnormal accretion of copper porphyrins, possibly resulting from erythroid and hepatic hemopoietic hyperactivity, as noted in hemolytic jaundice [3-8]. This is the most widely accepted cause of BBS.…”

“…This finding was based on in vitro spectroscopic measurements. The accumulation of biliverdin, a metabolic precursor of bilirubin, has also been proposed as the cause of pigmentation [3,4,8]. It is possible that all these 3 factors contribute towards the development of BBS.…”

“…However, phototherapy-induced bronzing is a self-limiting process; thus, continuing the phototherapy may decrease bilirubin levels and the risk of exchange transfusion. Le and Reese [3] suggested that development of BBS should not lead to suspension of the use of phototherapy for hyperbilirubinemia in infants with elevated conjugated bilirubin levels. Conversely, Peinado-Acevedo et al [10] stated that the continuation of phototherapy presented a risk of cholestasis to newborns with BBS and recommended that it be suspended; however, phototherapy can be reinitiated when the direct bilirubin level decreases and cholestasis has resolved.…”