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Management of severe hyperbilirubinemia in the cholestatic neonate: a review and an approach

Journal of Perinatology volume 42, pages 695–701 (2022)Cite this article

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Abstract

A review of the literature demonstrates that severe total hyperbilirubinemia (total serum bilirubin ≥ 20 mg/dL [340 µmol/L]) in some cholestatic term (≥37 weeks) and late-preterm (≥340/7–366/7 weeks) gestation neonates poses a risk for bilirubin-induced brain damage. When the direct bilirubin fraction is <50% of the total serum bilirubin this risk is associated with the total serum bilirubin alone and treatment decisions should be based on the total serum bilirubin. On the other hand, there are limited data on the risk of bilirubin-induced brain damage in the neonate with severe total hyperbilirubinemia and a direct bilirubin fraction that is equal to or exceeds 50% of the total serum bilirubin. When this rare combination occurs, efforts to keep the indirect bilirubin fraction from reaching severe levels might, nevertheless, be prudent.

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Acknowledgements

The authors gratefully acknowledge the generous assistance of Carrie Everstine of the Magee-Womens Hospital medical library.

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Authors and Affiliations

  1. Professor Emeritus Division of Newborn Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Jon F. Watchko

  2. Department of Pediatrics, Oakland University William Beaumont School of Medicine, Rochester, MI, USA

    M. Jeffrey Maisels

  3. Department of Pediatrics, Beaumont Children’s Hospital, Royal Oak, MI, USA

    M. Jeffrey Maisels

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  1. Jon F. Watchko
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JF Watchko conceptualized the review, carried out the literature search, drafted the initial manuscript, and reviewed and revised the manuscript. MJ Maisels critically reviewed the manuscript for important intellectual content, played an important role in interpreting the literature findings, and reviewed and revised the manuscript. Both authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

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Correspondence to Jon F. Watchko.

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Both authors report serving as a consultant in medico-legal cases related to kernicterus.

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Watchko, J.F., Maisels, M.J. Management of severe hyperbilirubinemia in the cholestatic neonate: a review and an approach. J Perinatol 42, 695–701 (2022). https://doi.org/10.1038/s41372-022-01330-8

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