Abstract
BackgroundSevere unconjugated hyperbilirubinemia carries the risk of neurotoxicity. Phototherapy (PT) and exchange transfusion (ET) are cornerstones in the treatment of unconjugated hyperbilirubinemia. Studies to improve ET efficacy have been hampered by the low application of ET in humans and by the lack of an in vivo model. The absence of an appropriate animal model has also prevented to determine the efficacy of adjunct or alternative treatment options such as albumin (Alb) administration.AimTo establish an in vivo model for ET and to determine the most effective treatment (combination) of ET, PT and Alb administration.MethodsGunn rats received either PT, PT+Alb, ET, ET+PT, ET+PT+Alb or sham operation (each n = 7). ET was performed via the right jugular vein in ∼20 min. PT (18 µW/cm2/nm) was started after ET or at T0. Albumin i.p. injections (2.5 g/kg) were given after ET or before starting PT. Plasma unconjugated bilirubin (UCB), plasma free bilirubin (Bf), and brain bilirubin concentrations were determined.ResultsWe performed ET in 21 Gunn rats with 100% survival. At T1, ET was profoundly more effective in decreasing both UCB −44%, p<0.01) and Bf −81%, p<0.05) than either PT or PT+Alb. After 48 h, the combination of ET+PT+Alb showed the strongest hypobilirubinemic effect (−54% compared to ET).ConclusionsWe optimized ET for severe unconjugated hyperbilirubinemia in the Gunn rat model. Our data indicate that ET is the most effective treatment option, in the acute as well as the follow-up situation.
Highlights
Neonatal jaundice carries the risk of neurotoxicity, due to the deposition of unconjugated bilirubin (UCB) in the central nervous system
Our data indicate that exchange transfusion (ET) is the most effective treatment option, in the acute as well as the follow-up situation
Two phototherapy devices were developed according to the prototype that was designed by Ostrow et al and previously successfully used [11,17]
Summary
Neonatal jaundice carries the risk of neurotoxicity, due to the deposition of unconjugated bilirubin (UCB) in the central nervous system. Phototherapy (PT) is generally effective, but in some neonates the plasma bilirubin concentrations become dangerously high or rise rapidly despite PT. In these patients PT might fail to prevent bilirubin-induced brain damage, and for these patients exchange transfusion (ET) is indicated. Severe unconjugated hyperbilirubinemia carries the risk of neurotoxicity. Phototherapy (PT) and exchange transfusion (ET) are cornerstones in the treatment of unconjugated hyperbilirubinemia. The absence of an appropriate animal model has prevented to determine the efficacy of adjunct or alternative treatment options such as albumin (Alb) administration
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