title: Simulation of bilirubin detoxification in the newborn using an extracorporeal bilirubin oxidase reactor.
abstract: Jaundice, which is characterized by an excessive accumulation of bilirubin in the blood and tissues, occurs in 13% of newborns. The common treatments for neonatal jaundice are phototherapy and blood exchange transfusion. A novel approach using an extracorporeal blood filter containing immobilized bilirubin oxidase was recently proposed to detoxify jaundiced blood, and a prototype device markedly reduced serum bilirubin in genetically jaundiced Gunn rats. The primary toxicologic effect in that study was a 20% reduction in red blood cell count. Using a compartmental model for bilirubin metabolism, a mathematical simulation of the extracorporeal treatment's ability to reduce serum bilirubin levels in jaundiced infants is presented. Using a 10-mL reactor volume containing immobilized bilirubin oxidase, the simulation predicts a 32 to 65% decrease in plasma bilirubin concentration over a 4-h treatment for a 2 kg preterm hyperbilirubinemic newborn. In addition, a new approach to altering support material has essentially eliminated red blood cell lysis in vivo using Gunn rats and in vitro using adult blood.
authors: Department of Chemical Engineering, MIT, Cambridge 02139.
authors: C J
authors: CJ
authors: Mullon
authors: C M
authors: CM
authors: Tosone
authors: R
authors: R
authors: Langer
mesh_terms: D001663:Bilirubin / Q000097:blood* / Q000378:metabolism; D004800:Enzymes, Immobilized; D005112:Extracorporeal Circulation; D006440:Hemofiltration; D006801:Humans; D007231:Infant, Newborn; D007567:Jaundice, Neonatal / Q000097:blood / Q000378:metabolism / Q000628:therapy*; D008962:Models, Theoretical; D010088:Oxidoreductases; D044925:Oxidoreductases Acting on CH-CH Group Donors; D014018:Tissue Distribution
chemical_list: D004800:Enzymes, Immobilized; D010088:Oxidoreductases; D044925:Oxidoreductases Acting on CH-CH Group Donors; C042401:bilirubin oxidase; D001663:Bilirubin