title: Usefulness of the bilirubin/albumin ratio for predicting bilirubin-induced neurotoxicity in premature infants.
abstract: Unconjugated hyperbilirubinaemia occurs in almost all premature infants and is potentially neurotoxic. Treatment is based on total serum bilirubin (TSB), but treatment thresholds are not evidence based. Free bilirubin (Bf)-that is, not bound to albumin, seems a better parameter for bilirubin neurotoxicity, but measurements of Bf are not available in clinical practice. The bilirubin/albumin (B/A) ratio is considered a surrogate parameter for Bf and an interesting additional parameter in the management of hyperbilirubinaemia. This paper reviewed the evidence supporting the use of B/A ratios for predicting bilirubin-induced neurological dysfunction (BIND) including neurodevelopmental delay in jaundiced premature infants (gestational age less than 32 weeks). A literature search was performed and six publications reviewed regarding B/A ratios in the management and outcome of jaundiced premature infants. No prospective clinical trials had been undertaken to show whether bilirubin-induced neurotoxicity is reduced or whether unnecessary treatment is avoided by using the B/A ratio in addition to TSB. Recently, a randomised controlled trial evaluating the effect of the additional use of the B/A ratio on neurodevelopmental outcome in jaundiced premature infants has been initiated. Based on the prevailing evidence many authorities suggest that the additional use of the B/A ratio may be valuable when evaluating jaundiced premature infants.
authors.affiliation: Department of Pediatrics, Division of Neonatology, University Medical Center Groningen, The Netherlands. c.hulzebos@bkk.umcg.nl
authors.forename: C V
authors.initials: CV
authors.lastname: Hulzebos
authors.forename: D E
authors.initials: DE
authors.lastname: van Imhoff
authors.forename: A F
authors.initials: AF
authors.lastname: Bos
authors.forename: C E
authors.initials: CE
authors.lastname: Ahlfors
authors.forename: H J
authors.initials: HJ
authors.lastname: Verkade
authors.forename: P H
authors.initials: PH
authors.lastname: Dijk
mesh_terms: D001663:Bilirubin / Q000032:analysis*; D006801:Humans; D051556:Hyperbilirubinemia, Neonatal / Q000175:diagnosis; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000175:diagnosis*; D007647:Kernicterus / Q000175:diagnosis* / Q000209:etiology; D010789:Phototherapy; D011237:Predictive Value of Tests; D012709:Serum Albumin / Q000032:analysis*
chemical_list: D012709:Serum Albumin; D001663:Bilirubin