Reserve albumin binding capacity, salicylate saturation index, and red cell binding of bilirubin in neonatal jaundice

105 blood samples from 72 infants, mostly with jaundice due to haemolytic disease, were analysed for reserve albumin binding capacity (HBABA method), salicylate saturation index (SI), and red cell binding of bilirubin. 2 infants with clinical symptoms of bilirubin encephalopathy had abnormally large amounts of red cell bound bilirubin, though the HBABA binding capacity and salicylate saturation index did not suggest a risk of bilirubin encephalopathy. On the other hand, 48 of the other samples showed `risk values' for saturation index and 2 of the other samples showed such values as judged by the HBABA method. The discrepancies between these findings are discussed. It is suggested that determination of red cell bound bilirubin may have clinical value in patients with neonatal jaundice, especially in cases of suggested kernicterus.

KERNICTERUS ASSOCIATED WITH PERINATAL ASPHYXIA AND DRUG THERAPY

Experimental studies suggest that a variety of factors play a role in the pathogenesis of kemicterus—protein-binding, acidosis, anoxia, hypoglycemia, etc. Certain drugs probably play a role also. At present, none of these factors are clearly enough defined or capable of quan titation even to the limited degree that is ac knowledged for the bilirubin level. However, their expressions are definite enough at this time to be considered when reaching what is still fundamentally a clinical judgment as to therapy in patients with hyperbilirubinemia in whom exchange transfusion is not clearly indi cated by the level of bilirubin alone or in com bination with blood type, hemoglobin, reticulo cyte count and Coombs test.

It seems clear that judgments about the safety of a drug for the fetus cannot be based entirely on experience with newborns or on experiments with newborn animals. The dan gers to a newborn infant which are inherent in a particular drug may be multiple and may not be fully known.

KERNICTERUS IN NEWBORN RABBITS

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