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Am J Perinatol 2018; 35(11): 1107-1112
DOI: 10.1055/s-0038-1641746
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Might Bilirubin Serve as a Natural Antioxidant in Response to Neonatal Encephalopathy?

Alona Bin-Nun
1   Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel
,
Francis B. Mimouni
1   Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel
2   Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
,
Yair Kasirer
1   Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel
,
Irina Schors
1   Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel
,
Michael S. Schimmel
1   Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel
3   The Faculty of Medicine, Hebrew University, Jerusalem, Israel
,
Michael Kaplan
3   The Faculty of Medicine, Hebrew University, Jerusalem, Israel
,
Cathy Hammerman
1   Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel
3   The Faculty of Medicine, Hebrew University, Jerusalem, Israel
› Author Affiliations
Funding None.
Further Information

Publication History

07 November 2017

08 March 2018

Publication Date:
10 April 2018 (online)

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Abstract

Background Neonatal asphyxia is often associated with hepatic injury. We hypothesized that this might lead to increased bilirubin concentrations.

Study Design Term neonates admitted between January 2015 and April 2017 who remained hospitalized for ≥ 4 days and who had serial serum bilirubin concentrations recorded were divided into those with neonatal encephalopathy (NE) and controls. Serial serum bilirubin concentrations during the first days of life were compared between groups.

Results Twenty-nine neonates with NE and 84 age-matched controls were identified. Mean total serum bilirubin concentrations of NE babies were significantly lower than those controls throughout the first days of life. At 96 hours of age, NE serum bilirubin concentrations were 4.5 (3.2, 5.8) versus controls of 10.5 (9.4, 11.5) mg/dL (p < 0.0001). The mean area under the curve (AUC) for the NE group was 268 (215, 321) versus 663 (608, 718), p < 0.0001, for the control group. All of the NE babies remained below the 40th percentile of the Bhutani curve and none required phototherapy.

Conclusion Contrary to our hypothesis, bilirubin concentrations in NE infants are significantly lower than expected during the first 4 days postnatally. We speculate that, under conditions of severe oxidative stress, bilirubin is consumed as an antioxidant.

Keywords

bilirubin - antioxidant - Gamma-glutamyltransferase - aspartate transferase - alanine transferase