High prevalence of cholestasis at a tertiary neonatal intensive care unit

Successful management of biliary atresia in an 834 g preterm infant

“…Early diagnosis and KPE are associated with improved outcomes 1 . However, early diagnosis of BA is challenging in preterm infants, especially in extremely‐low‐birthweight (ELBW) infants, who are vulnerable to cholestasis 2 . Mourier et al reported two cases of BA in preterm infants born at 31 and 35 weeks’ gestation who had initially normal‐colored stools despite cholestasis, 3 which support the findings in the present case.…”

“…1 However, early diagnosis of BA is challenging in preterm infants, especially in extremelylow-birthweight (ELBW) infants, who are vulnerable to cholestasis. 2 Mourier et al reported two cases of BA in preterm infants born at 31 and 35 weeks' gestation who had initially normal-colored stools despite cholestasis, 3 which support the findings in the present case. Although intraoperative cholangiography has been reported as the gold-standard method for BA diagnosis, choosing a surgical approach for ELBW infants is debated given the risk of surgical complications.…”

A Novel Method for Measuring Serum Unbound Bilirubin Levels Using Glucose Oxidase–Peroxidase and Bilirubin-Inducible Fluorescent Protein (UnaG): No Influence of Direct Bilirubin

“…Due to the development of perinatal medical care in recent years, severely ill infants (e.g., extremely preterm infants and infants with gastrointestinal anomalies or chromosomal disorders) can now survive. Neonatologists are encountering an increase in opportunities to treat and care for newborn patients exhibiting high DB/TB ratios in NICUs [ 8 ]. These newborn patients are more likely to develop hypoalbuminemia, with many possibilities to use drugs that alter albumin binding (e.g., antimicrobial drugs, fat formulations, and indomethacin), which consequently affect bilirubin binding to albumin to result in hyper-unbound bilirubinemia [ 1 ].…”

“…The UB values displayed by the UB-Analyzer using the GOD–POD method can register higher than is actually present when the DB/TB ratio is high; a DB/TB ratio >10% overestimates UB levels compared to a ratio <10%, although the specific effect of DB on UB measurements by the GOD–POD method remains unclear [ 1 ]. This problem is more significant for newborn care in the neonatal intensive care unit (NICU) because >20% of hospitalized infants in Japanese NICUs have conjugated hyperbilirubinemia, which is especially prevalent among extremely preterm infants, small-for-gestational infants, and infants with gastrointestinal anomalies or chromosomal disorders [ 8 ].…”