BILIRUBIN ALBUMIN BINDING (BAB) ASSAY IN NEWBORN INFANTS BEFORE, DURING AND AFTER EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)

Abstract

Red blood cell destruction during ECMO may increase the risk for hyperbilirubinemia and bilirubin neurotoxicity. For this reason we performed bilirubin binding studies on 12 newborn infants (mean ± SD, gestational age 37.6±3.6 wks, birth wt 2889±706 gms) managed with ECMO for respiratory failure. The mean duration of ECMO was 91.1±37.2 hrs. Bilirubin binding studies including reserve bilirubin binding capacity (RBBC), and saturation index (SI) were performed using a bilirubin fluorometer. No significant changes pre, on, or post ECMO were noted on the hemoglobin and fibrinogen levels. The bilirubin levels were not significantly different pre and on ECMO and were lower post ECMO. As shown in the table, there were significant changes pre, on, and post ECMO plasma hemoglobin values. Significant changes between pre and on ECMO values only were noted on the infant's platelet, fibrin split products and SGOT levels. Thus, the hemolysis that occurs during ECMO does not adversely effect the RBBC and SI from any alterations in the bilirubin load or in the BAB sites. ECMO would not predispose an infant to bilirubin neurotoxicity because of the normal BAB values pre, on, and post ECMO.