Reduction In Bilirubin Levels Research Articles

A prospective study on the causes of hyperbilirubinemia and its clinical markers in term and near-term newborns admitted to a tertiary care hospital in Patna, India

This study aimed to investigate the root causes, prognostic factors, and therapeutic strategies for neonatal hyperbilirubinemia among term and near-term infants admitted to the Neonatal Intensive Care Unit (NICU) at IGIMS, Patna. Furthermore, the research aimed to analyze the clinical progression of these infants throughout their NICU stay.Conducted within the NICU at IGIMS, Patna, Bihar, this study encompassed term and late preterm infants admitted with serum bilirubin levels exceeding 12 mg/dl. The primary focus was on identifying risk factors, etiological factors, and the clinical profile of these infants during their NICU tenure.The study examined birth weight distribution and concurrent medical conditions. Parameters included the initiation of phototherapy based on bilirubin levels and treatment methodologies. Out of the 210 infants studied, 27.14% and 47.62% weighed between 2001 and 2500 grams. The most prevalent causes were physiological (129 cases), fetal prematurity (30 cases), birth asphyxia (7 cases), and prolonged labor (18 cases). Idiopathic causes were observed in 28 instances, ABO incompatibility in 7 cases, and Rh incompatibility in 7 cases. G6PD deficiency was identified once. At the commencement of phototherapy, 19.52% had bilirubin levels between 12 and 15 mg/dl, 58.57% between 15.1 and 18 mg/dl, 11.91% above 20 mg/dl, and 10% between 18.1 and 20 mg/dl.Physiological causes emerged as the most frequent contributors to neonatal hyperbilirubinemia, followed by septicemia and idiopathic factors. Infrequent causes included blood group incompatibility. Phototherapy was established as a cost-effective and efficient method for reducing bilirubin levels in neonatal jaundice. Exchange transfusion proved to be a safe therapeutic measure in cases of severe hyperbilirubinemia. Blood group incompatibility was the main determinant requiring exchange transfusion.

THE EFFECT OF MASSAGE ON SERUM BILIRUBIN LEVELS AND NEONATUS BODY WEIGHT WITH PHOTOTHERAPY

Approximately 25-50% of newborns experience physiological hyperbilirubinemia in the first week of life, 80% occur in premature babies and 60% in full-term babies. Hyperbilirubinemia can be toxic and dangerous, such as encephalopathy. At Ummi Hospital, Bogor, the number of babies born from January to April 2021 was 704, and 11.4% had hyperbilirubinemia and no baby massage intervention had been carried out. Massage for newborns with hyperbilirubinemia reduces bilirubin levels and increases the baby's weight. This study aims to find out whether massage can reduce serum bilirubin levels and increase the weight of hyperbilirubinemia babies who receive phototherapy. This research was conducted in the perinatology room at Ummi Hospital, Bogor, Indonesia with ethical permit no. 02/KEPK/X/2021. The research design used a quasi-experimental pretest-posttest with a control group design, with a sample of 40 hyperbilirubinemia babies. After analysis using the dependent t-test and independent t-test, the results of the study showed that there was no significant difference between body weight before the intervention and after the intervention with p > 0.05 in the intervention group (p=0.054) and the control group (p =0.286). There was a significant difference in bilirubin levels (p<0.05) before and after the intervention in both the intervention group and the control group (p=0.001). Conclusion: Phototherapy alone or combined with massage can reduce serum bilirubin levels in babies. Adding massage to provide comfort to the baby and other benefits.

Effect of vitamin E supplementation on bilirubin levels in infants with hyperbilirubinemia: a double-blind randomized clinical trial.

The effect of vitamin E supplementation on bilirubin levels in infants was previously explored, but the results were inconclusive. To examine the effect of vitamin E supplementation on bilirubin levels in term infants in the neonatal intensive care unit (NICU). This interventional double-blind randomized clinical trial was conducted in the Sanandaj Besat Hospital NICU. Enrolled newborns were between 37 and 42 weeks and 6 days of gestation and required phototherapy according to American Academy of Pediatrics clinical guidelines. A total of 138 infants were randomly assigned to vitamin E (n=68) or placebo (n=70) groups. In addition to phototherapy, the vitamin E group received 0.5 mL (5 IU) of supplemental vitamin E daily, whereas the placebo group received 0.5 mL of oral dextrose daily. STATA 17 was used for the data analysis. Changes in bilirubin levels at 24 hours postintervention did not differ significantly from baseline in either group. Vitamin E supplementation did not significantly reduce total bilirubin levels at 24 hours postintervention (mean difference [MD], -0.18; P=0.204; 95% confidence interval [CI], -1.39 to 1.02). However, the vitamin E group exhibited lower total bilirubin levels than the placebo group at 48 hours postintervention (MD, 0.18; P=0.365; 95% CI, -0.89 to 1.27) and 72 hours (MD, 0.36; P=0.356; 95% CI, -2.34 to 1.61), although the differences were not statistically significant. A subgroup analysis revealed that female infants experienced a greater reduction in total bilirubin levels than male infants. Infants administered vitamin E versus placebo demonstrated similar reductions in bilirubin levels and hospital stays. Although the average bilirubin changes did not differ significantly between groups, the vitamin E group showed a more noticeable reduction over time, indicating a positive effect of vitamin E supplementation on serum bilirubin reduction. Trial registration: IRCT20220806055625N2 (registered December 26, 2022; http://irct.ir/trial/67135).

Forgoing Exchange Transfusion in Neonatal Hyperbilirubinemia: A Single-Center Retrospective Cohort Study.

Unconjugated hyperbilirubinemia is part of the everyday life of the neonatal period as it reflects the adaptation of the metabolism of bilirubin. The neonatal hyperbilirubinemia usually resolves spontaneously, but it can also be the cause of an acute or chronic encephalopathy known as kernicterus. Regardless of the cause, the goal of therapy is to prevent this neurotoxicity while not causing undue harm. Phototherapy and, if it is unsuccessful, exchange transfusion (ECT)remain the primary treatment modalities used to keep the maximal total serum bilirubin (TSB) below pathologic levels. This is a descriptive retrospective cohort study of 69 live neonates hospitalized in the Department of Neonatology and Neonatal Resuscitation of Mohammed VI University Hospital with unconjugated hyperbilirubinemia requiring ECT and treated with intensive phototherapy instead, spanning five years from March 2016 to March 2021. We aim to demonstrate the effectiveness of phototherapy in achieving prolonged reduction of bilirubin levels and the prevention of neurological complications and to compare our results with those in the literature. The use of intensive phototherapy in the treatment of neonatal unconjugated hyperbilirubinemia is very effective in lowering total serum bilirubin when its level is in the range of exchange transfusion, and it has succeeded in preventing the neurological complications of severe hyperbilirubinemia. Through this study, it can be seen that phototherapy is an efficacious, simpler, and less hazardous alternative to exchange transfusion in achieving a sustained reduction of bilirubin levels and preventing neurological complications.

LITERATURE REVIEW: PENGARUH PIJAT BAYI TERHADAP PERUBAHAN KADAR BILIRUBIN DIRECT DAN BILIRUBIN INDIRECT PADA BAYI DENGAN TERAPI SINAR

Infant massage is one of the tactile stimulation and has become a hereditary tradition and has been studied in research in the fields of neonatal science, neurology, psychology, and several other health sciences. The incidence of hyperbilirubinemia in general is a physiological problem that occurs in almost 80% of newborns with prematurity and up to 60% of aterm newborns and occurs in the first week of life. This study aims to determine the implementation of massage therapy in neonates to reduce bilirubin levels. The research method used literature review by searching articles obtained through databases including Science Direct, Elsevier and Google Scholar. The results showed five articles involving neonates in five countries with a randomized control trial (RCT) design, stating that infant massage therapy is the most influential in reducing the degree of neonatal jaundice in the group given massage therapy because it can stimulate defecation. In addition, the provision of physiological massage therapy can improve the circulation of blood flow, lymph and tissue fluids thereby increasing bilirubin output.

Effectiveness of Tactile and Kinaesthetic Stimulation on Hyperbilirubinemia: A Feasibility Study

Introduction: Neonatal hyperbilirubinemia is common among newborns, often necessitating hospitalisation and posing a risk of neural complications. Phototherapy, commonly used to treat hyperbilirubinemia, also has side effects, including eye and genital harm, dehydration, diarrhoea, and bronze baby syndrome. Therefore, there is a need to find alternatives or reduce treatment duration. Aim: To investigate the efficacy of tactile and kinaesthetic stimulation as adjunctive therapies with phototherapy for reducing bilirubin levels in preterm neonates with hyperbilirubinemia. Materials and Methods: A randomised controlled feasibility study, including 12 preterm neonates with hyperbilirubinemia, was conducted in the Neonatal Intensive Care Unit (NICU) of a Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Mullana, Ambala, India. The experimental group (n=6) received three sessions of tactile and kinaesthetic stimulation for 15 minutes per session alongside phototherapy, compared to a control group (n=6) receiving phototherapy alone for three days. Results: While no significant differences (p>0.05) in demographics of neonates were observed, both groups experienced significant reductions (p<0.001) in Total Serum Bilirubin (TSB) and Transcutaneous Bilirubin (TCB) levels, with change scores of 7.88±2.29 (TSB experimental), 7.84±2.85 (TSB control), 6.63±2.77 (TCB experimental), and 6.27±1.92 (TCB control). However, the change in mean levels of TSB and TCB was not significantly different when compared between the two groups (p>0.05). Conclusion: There were significant reductions in TSB and TCB levels from Day 1 to Day 3 within each group. Both interventions were equally effective in reducing the bilirubin levels in the neonates.

Hidden Effect of Baby Massage on Hyperbilirubinemia

Hyperbilirubinemia can occur when the level of bilirubin in the blood is more than 5 mg/dL, clinically characterized by the presence of jaundice with physiological and non-physiological causes. The main treatment for cases of hyperbilirubinemia today is phototherapy. However, in recent years there have been alternative interventions carried out, one of which is baby massage. The purpose of this paper is to analyze the effect of giving massage on the bilirubin levels of infants who have hyperbilirubinemia based on empirical studies of the last 10 years. The writing design uses a literature review with inclusion criteria according to the PICOS format. Methods to find sources or articles through the Pubmed, Proquest, Scient Direct, and Google Scholar databases (2016-2021) published in English and Indonesian. The keywords used are related to hyperbilirubinemia and baby massage. Based on the 10 articles reviewed, it was found that baby massage was given 1 to 3 times a day with a duration of 15-20 minutes in every session. Evaluation of bilirubin levels can use serum bilirubin levels or transcutaneous bilirubin levels, besides that giving massage also increases the frequency of defecation which plays a role in removing bilirubin from the baby's body. Baby massage is expected to prevent and treat standardized hyperbilirubinemia so that it can become uniform and as an alternative intervention in reducing bilirubin levels in infants

Hepatitis-Induced Hemolysis in Pediatrics: A Rare Case Report

This article presents a case study of a 6-year-old boy diagnosed with acute Hepatitis A virus (HAV) infection compounded by glucose-6-phosphate dehydrogenase (G6PD) deficiency. The patient exhibited a constellation of symptoms, including low-grade fever, upper abdominal pain, fatigue, and anorexia, over an 8 to 10-day period. Notably, jaundice, dark-colored urine, and hepatomegaly were prominent clinical features. Laboratory investigations revealed severe intravascular hemolysis, evidenced by a decline in hemoglobin, elevated reticulocytes, and unconjugated hyperbilirubinemia. The diagnosis of HAV hepatitis was confirmed through positive IgM anti-hepatitis A virus. Over the subsequent two weeks, the patient experienced peak levels of serum bilirubin, AST, and ALT. Conservative management focused on avoiding hepatotoxic drugs, ensuring adequate urine output, and monitoring metabolic parameters. Gradual improvement was observed over the subsequent month, with a significant reduction in bilirubin levels, restoration of hemoglobin, and a decline in liver enzymes. The patient was discharged for outpatient follow-up, and four weeks post-onset, G6PD levels approached normal, emphasizing the importance of comprehensive care in such complex cases. This case underscores the intricate interplay between viral hepatitis and G6PD deficiency, contributing valuable insights into the clinical presentation and management of severe hemolysis in this specific population

PIJAT BAYI DAN PENURUNAN KADAR BILIRUBIN BAYI IKTERIK: A SCOPING REVIEW

Jaundice is a disorder manifested by yellow discoloration of the skin, sclera and mucous membranes due to an increase in total serum bilirubin (TSB) in the circulation which is usually called hyperbilirubinemia. The aim of this study was to determine the effectiveness of massage to reduce bilirubin levels in icteric babies undergoing phototherapy. The type of research was a systematic review with PRISMA method. Data was accessed from; Google Scholar, PubMed, Research gate, One search, Garuda in the period 2013 to 2023. The article is original research, written in English or Indonesian and the research design is in the form of experimental research with designs: quasi experiments and randomized controlled trials. The number of articles that correspond is 7 articles. The research subjects were healthy babies and babies with jaundice. The results of the systematic review are that regular massage therapy in infants with jaundice undergoing phototherapy has an effective effect in reducing total serum bilirubin (TSB), increasing bilirubin excretion with defecation, reducing the duration of hospitalization. This complementary therapy is an effort to increase the effectiveness and efficiency of treating icteric babies during the hospitalization period.   

An Overview on Neonatal Jaundice

A significant proportion of term and preterm infants develop neonatal jaundice. Jaundice in a healthy term infant is the most common reason for readmission to hospital. Jaundice is caused by a significant increase in serum bilirubin levels, largely due to the breakdown of red blood cells. Bilirubin is transported in the blood as 'unconjugated' bilirubin, largely bound to albumin. The bilirubin is converted into a conjugated form by the liver, which is excreted in the bile. Very high levels of unconjugated bilirubin led to neurotoxicity. In most infants, severe hyperbilirubinemia is caused due to an increase in bilirubin production (e.g., due to haemolysis) and thus reducing bilirubin production is a rational approach for its management. The situation can become critical in infants with an associated impaired bilirubin elimination mechanism as a result of a genetic deficiency and polymorphism. The simplest way to reduce bilirubin levels is by phototherapy. Current management of jaundice in the UK is guided by the NICE guideline.1

Bilirubin- and Blue-Green Light-Induced Damage of Human Erythrocytes

Phototherapy is widely used for neonatal hyperbilirubinemia treatment; however, the most important but not completely recognized issue is the determination of the optimal spectral range of light that provides an effective reduction of bilirubin level in the blood of a newborn with minimal adverse side effects. This study demonstrates that the exposure of radiation from LED sources of blue (emission wavelength λ max = 463 nm, FWHM 20 nm) and green (λ max = 517 nm, FWHM 38 nm) spectral regions to the erythrocyte suspension with the same energy dose (D = 14.4 J/cm 2 ) leads to approximately equally effective hemolysis of erythrocytes. It is concluded that the damage of erythrocyte membranes is caused by the excitation of endogenous porphyrin and flavin photosensitizers contained in the cells in low concentrations, but characterized by high efficiency of singlet oxygen generation. When bilirubin is added to the erythrocyte suspension, a spontaneous (dark) erythrocyte hemolysis intensifies, but the light-induced hemolysis slows down (compared to cells containing no bilirubin). Under the same conditions, the leakage of potassium ions from light-exposed erythrocytes is accelerating, with the light of green spectral region has a more pronounced effect, despite more intense absorption of blue light by bilirubin localized in cells.

The beneficial effects of infant’s massage on jaundiced neonates receiving phototherapy

Aim: To determine the effects of infant massage on newborns with jaundice who are on phototherapy. Methodology: We randomly assigned newborns(full-term) with jaundice to either a control group or a massage group while they were admitted for phototherapy. The medical data, including total feeding volume, weight, frequency of bowel movements, and level of bilirubin, was gathered and compared between two groups. Results: There were 25 neonates in the control group and 25 neonates in the test group. In comparison to the control group on the third day, the massage group showed significantly higher defecation frequency and significantly reduced bilirubin levels. There were no statistically significant differences in the two groups between body weights or food intake. Conclusion: The massaging of infant reduces bilirubin level and increases the frequency of faeces while they are receiving phototherapy for jaundice 

Respiratory Distress of Newborn dengan Pemantauan Respirasi dan Alih Baring untuk Mengatasi Hiperbilirubinemia di Ruang Neonatal Intensive Care Unit: Studi Kasus

Respiratory Distress of Newborn (RDN) is a common cause of newborns respiratory distress. The RDN appears within a few hours after birth, and mostly often appears soon after birth. RDN usually has symptoms of tachypnea with a respiratory rate of more than 60 breaths per minute accompanied by grunting, chest retractions, nostril breathing, and cyanosis. Asphyxia is one of the causes of RDN. In addition, asphyxia can cause an increase in bilirubin levels in newborns leading to hyperbilirubinemia.
 This study was to observe the patient's breathing pattern and bilirubin levels among infants with RDN. A descriptive study, specifically case study design was utilized. The subject of this case study was baby H who diagnosed with RDN with CPAP installed on the 4th day.
 Results showed that monitoring vital signs for 3 days can improve breathing patterns and prevent respiratory failure. Meanwhile, phototherapy along with bed transfer has been shown to reduce bilirubin levels from bilirubin levels before the intervention, namely 20.65 mg/dl to 7.57 mg/dl after the intervention.
  Respiratory monitoring can improve respiratory rate. In addition to phototherapy, infants can also be given bed rest while monitoring vital signs to treat hyperbilirubinemia in RDN infants.

Impact of Saccharomyces boulardii on jaundice in premature infants undergoing phototherapy

ObjectivesTo evaluate the therapeutic effect of Saccharomyces boulardii supplementation on jaundice in premature infants undergoing phototherapy. MethodsIn this article, the authors reviewed 100 hospitalized jaundiced premature infants under 35 weeks of gestational age. All infants were assigned to a control group (n = 45) and a treatment group (n = 55) randomly. The infants in the treatment group received S. boulardii supplementation by undergoing phototherapy and the infants in the control group were only treated by phototherapy. The total serum bilirubin levels were detected before and at the end of phototherapy, and transcutaneous bilirubin levels were measured on the 1st, 4th, 8th and 15th day of treatment. The duration of jaundice resolution and phototherapy, stool frequency, and characteristics were compared after phototherapy. ResultsThe duration of jaundice resolution and phototherapy were shortened. Total serum bilirubin level was lower than the control group at the end of phototherapy (p < 0.05). Transcutaneous bilirubin levels decreased more significantly on the 8th and 15th day of treatment (p < 0.05), while there were no significant differences on the post-treatment 1st and 4th day (p > 0.05). In addition, bowel movements including stool frequency and Bristol Stool Form Scale ratings of stools also improved after treatment. ConclusionsS. boulardii in combination with phototherapy is effective and safe in reducing bilirubin levels and duration of phototherapy, accelerating jaundice resolution in premature infants with jaundice. The procedure also provided an ideal therapeutic effect of diarrhea induced by phototherapy to promote compliance and maternal-infant bonding.

Pelaksanaan Terapi Pijat Bayi pada Nenonatus dengan Hiperbilirubin

This study aims to identify the implementation of various infant massage therapies in neonates to reduce bilirubin levels using the scoping review method. The research method used in this research is a scoping review that follows the JBI methodology guidelines with searches conducted in several databases, namely PubMed, Web of Science, EMBASE, and Google Scholar. The results showed 12 articles involving 665 neonates in five countries, nine with a randomized control trial (RCT) design, and three quasi-experimental studies. In conclusion, the mechanism of infant massage therapy that most underlies the reduction of neonatal jaundice in the group receiving massage therapy is the stimulation of bowel movements.&#x0D;  &#x0D; Keywords: Hyperbilirubin, Neonate, Infant Massage Therapy

The efficacy of infrared filter window film to prevent hyperthermia in neonatal hyperbilirubinemia with conventional phototherapy: a randomized control trial.

Phototherapy is the first-line treatment of neonatal hyperbilirubinemia. Possible side effects caused by phototherapy include hyperthermia and dehydration. Currently, there are many types of infrared blocking film for potential use in reducing infrared radiation exposure and preventing hyperthermia. This study aims to evaluate the efficacy of infrared blocking film in preventing hyperthermia during the first 24h of phototherapy. The randomized controlled trial study was carried out in 44 newborns with hyperbilirubinemia. Infrared filter film with 75% visible light transmission and 90% infrared rejection was used in the study. Body temperature was measured for the assessment of the efficacy of filter film from axillary and rectal routes. There was a significantly lower incidence of hyperthermia from the axillary temperature in the group with infrared blocking film compared to the control group (p = 0.031). The axillary temperature between before and after initiation of phototherapy in filter film group was significantly better (p=0.008). According to efficacy of treatment, the study demonstrated that infrared filter film did not interfere with the efficacy of phototherapy in reducing bilirubin level. The infrared filter film was significantly more effective in preventing hyperthermia from phototherapy in the first 24h without causing any significant difference in reduction of bilirubin level. TCTR20190619001.

Functionalization of Poly(styrene-co-methyl methacrylate) Particles for Selective Removal of Bilirubin.

Hyperbilirubinemia is one of the main causes of death in patients with severe hepatic problems, which justifies the research for bilirubin removal solutions. In this study, St-MMA particles with PEGMA and/or GMA brushes were synthesized. First, the recipe for St-MMA was optimized and then adapted for PEGMA and GMA incorporation. Different solvents were then assayed to improve the BSA immobilization capacity of the particles. Ethyl lactate proved to be the best solvent, reaching a BSA immobilization capacity improvement of up to 60% for St-MMA-GMA-PEGMA particles. These particles also presented the best results for BR removal from PBS. No significant differences in the final capacity for BR removal from PBS media were observed when BSA was attached to the particles; however, the kinetics were greatly improved, requiring half the time. Finally, St-MMA-GMA-PEGMA particles that were wetted in EL with BSA reduced the bilirubin concentration in plasma from levels that threaten the survival of critical patients to levels close to those of healthy individuals in less than 30 min. On the contrary, particles without BSA were unable to remove bilirubin from plasma. Thus, the attachment of albumin to the particles plays a key role in selectively reducing bilirubin levels.

ANALISIS HASIL KALIBRASI ALAT PHOTOTHERAPY MERK GEA MEDICAL TYPE XHZ-90

Babies born prematurely always increase every year. For this reason, it is necessary to take proper care so that the baby remains in good health. One of the treatments for premature babies is phototherapy to reduce bilirubin levels in the baby's body. In order for the phototherapy process to run as expected, of course the phototherapy equipment used in the treatment must be of good quality and quality. For this reason, quality assurance and phototherapy equipment need to be carried out through a calibration process. In this study, calibration of the GEA medical type XHZ-90 phototherapy tool was carried out. Calibration is carried out by following the standard reference work method from the Ministry of Health in 2018. Calibration is carried out by checking the physical and function of the equipment which gains a weight of 10%, electrical safety inspection of the appliance with a weight gain of 36%, and measuring the performance of the instrument, namely spectral irradiance with a weight gain of 50%. . So that the total weight gain can be 96% and it can be concluded that this tool is functioning properly and within the tolerance limits of use. The uncertainty value in the measurement of spectral irradiance takes into account the sources of uncertainty types A and B. The combined uncertainty calculation from several sources for the measurement of spectral irradiance is 1.116. This value has met the uncertainty tolerance limit value of ≥ 4.

Effect of Single Dose Fenofibrate as an Adjunct to Phototherapy on Unconjugated Neonatal Hyperbilirubinemia: A RCT

Background: Fenofibrate is used as an adjunct therapy to reduce bilirubin level and duration of phototherapy. This study was done to determine the efficacy of fenofibrate in the treatment of unconjugated neonatal hyperbilirubinemia.&#x0D; Materials &amp; Method: Total 60 neonates were enrolled and devided into two groups. In group A, a single dose of oral fenofibrate (10mg/kg) was given along with phototherapy, and Group B only phototherapy. Blood samples were collected every 24 hours for total and indirect bilirubin. SGPT was done before and after 24 hours of giving fenofibrate.&#x0D; Result: Baseline serum bilirubin was 16.86± 0.89 in group A and 17.31± 1.19 in group B. After 24 hours of starting phototherapy, the bilirubin level came down to a lower value of 14.83 ± 0.95 mg/dl in group A and 15.73 ± 1.32 mg/dl in group B. After 48 hours it was 12.85 ± 1.06 mg/dl and 14.20 ± 1.24 mg/dl in group A and group B respectively. (P-value 0.004 and 0.001). The mean time needed for phototherapy was 51.20 ± 8.29 hours in group A and 70.40± 6.08 hours in group B (P-value 0.001). The duration was shorter in the fenofibrate group in comparison to the control group. No side effects of fenofibrate were observed after a single dose administration.&#x0D; Conclusion: Administration of a single dose of fenofibrate as an adjunct along with phototherapy to neonates showed a significant reduction of serum bilirubin and duration of phototherapy.&#x0D; BANGLADESH J CHILD HEALTH 2021; VOL 45 (2) : 89-93

A Potential Role of Keratinocyte-Derived Bilirubin in Human Skin Yellowness and Its Amelioration by Sucrose Laurate/Dilaurate.

Sallow and/or dull skin appearance is greatly attributable to the yellow components of skin tone. Bilirubin is a yellow chromophore known to be made in the liver and/or spleen and is transported throughout the body via the blood stream. Recent publications suggest bilirubin may be synthesized in other cells/organs, including the skin. We found human keratinocytes express the transcripts involved in bilirubin biosynthesis. In parallel, we also found human keratinocytes could indeed synthesize bilirubin in monolayer keratinocytes and in a 3D human skin-equivalent model. The synthesized amount was substantial enough to contribute to skin yellowness. In addition, oxidative stress enhanced bilirubin production. Using UnaG, a protein that forms a fluorescent species upon binding to bilirubin, we also visualized the intracellular expression of bilirubin in keratinocytes. Finally, we screened a compound library and discovered that the sucrose laurate/dilaurate (SDL) combination significantly reduced bilirubin levels, as well as bilirubin-mediated yellowness. In conclusion, bilirubin is indeed synthesized in epidermal keratinocytes and can be upregulated by oxidative stress, which could contribute to chronic or transient yellow skin tone appearance. Application of SDL diminishes bilirubin generation and may be a potential solution to mitigate yellowish and/or dull skin appearance.