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Date: | Wed, 24 Jan 2007 10:24:36 -0500 |
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I just wanted to throw my 2 cents in since the new AAP policy on
hyperbilirubinemia has disrupted my practice of medicine.
I like the discussions taking place over the role of free bilirubin and bound
bilirubin in the pathogenesis of kernicterus.
R. P. Wennberg, C. E. Ahlfors, V. K. Bhutani, L. H. Johnson, and S. M. Shapiro
Toward Understanding Kernicterus: A Challenge to Improve the Management of
Jaundiced Newborns
Pediatrics, February 1, 2006; 117(2): 474 - 485
My favorite quote in the article is this "TSB (TSB=total serum bilirubin) is, at
best, a poor risk indicator for kernicterus and, at worst, an excuse for not
intervening when intervention is necessary. Laboratory and available clinical
data are consistent with basic pharmacological principles in demonstrating that
Bf (free or unbound bilirubin)rather than TSB (analogous to free thyroxine and
thyroxine) is a critical serum factor involved in brain uptake of bilirubin and
subsequent neurotoxicity. To improve guidelines for managing
hyperbilirubinemia and minimize the number of unnecessary and at times
dangerous therapeutic interventions, there is need for a national strategy to
obtain prevalence and incidence kernicterus data and to identify Bf and TSB
levels and independent comorbid factors associated with reversible and
irreversible bilirubin encephalopathy."
It essentially says, we should do more research before we make these policy
statements. It's interesting that we can create risk zones for a disease that
we don't know the incidence or prevalence of. And that we don't quite know
if bilirubin is the only culprit in kernicterus.
My other questions is based on the risk factors that are in the statement.
Being Asian is a risk factor, being African -American is associated with lower
risk. My kids are both (plus being white and American Indian)....does that
mean their African American blood protects them from the Asian risk? I've
never figured that out.
Back to the trenches.
Jenny Thomas
Milwaukee, WI
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