title: Hyperbilirubinemia in infants with Gram-negative sepsis does not affect mortality.
abstract: BACKGROUND
  Sepsis is associated with an increased production of oxidant species and a decrease in endogenous antioxidant defenses. Mortality is high, especially when endotoxins are involved, e.g., in infants with Gram-negative sepsis. Yet, chronic as well as acute unconjugated hyperbilirubinemia has been shown to protect against endotoxin-induced shock in vivo in rats and in mice. We hypothesized that hyperbilirubinemia in infants with Gram-negative sepsis improves survival and/or mitigates the inflammatory response.
  
  
  OBJECTIVE
  To assess the relationships between serum bilirubin concentrations on the one hand, and leukocyte count, C-reactive protein and survival on the other hand, in infants with Gram-negative sepsis.
  
  
  METHODS
  Retrospectively, we retrieved clinical and biochemical data from infants less than 90 days of age with a blood culture-proven Gram-negative sepsis between January 1998 and December 2005.
  
  
  RESULTS
  We identified 92 infants with Gram-negative sepsis in the indicated period. Median gestational age was 29 (24-42) weeks. 22 Patients died. Preceding sepsis, median total serum bilirubin concentrations were below 150 μmol/L. Median concentrations of conjugated bilirubin concentrations increased (+63%, p<0.05), and median concentrations of unconjugated bilirubin decreased (-36%, p<0.05) in infants with Gram-negative sepsis. Median total bilirubin concentrations before and during sepsis were not significantly different between survivors and non-survivors. Changes in bilirubin concentrations were not significantly correlated with changes in either white blood cell count or C-reactive protein.
  
  
  CONCLUSIONS
  Present data do not support the concept that bilirubin positively affects survival or the inflammatory response in infants with Gram-negative sepsis.
authors.affiliation: Dept. of Pediatrics, Div. of Neonatology, University Medical Center Groningen, Hanzeplein 1, 9700 RB, The Netherlands. paulvandenbroek@gmail.com
authors.forename: Paul
authors.initials: P
authors.lastname: van den Broek
authors.forename: Henkjan J
authors.initials: HJ
authors.lastname: Verkade
authors.forename: Christian V
authors.initials: CV
authors.lastname: Hulzebos
mesh_terms: D016470:Bacteremia / Q000150:complications* / Q000401:mortality; D005260:Female; D005865:Gestational Age; D016905:Gram-Negative Bacterial Infections / Q000150:complications* / Q000401:mortality; D006801:Humans; D051556:Hyperbilirubinemia, Neonatal / Q000150:complications* / Q000401:mortality; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000401:mortality*; D008297:Male; D012189:Retrospective Studies