Ex uno plures: the concealed complexity of bilirubin species in neonatal blood samples

Abstract

Blood from jaundiced neonates often contains several isomers of bilirubin in addition to the biosynthetic isomer that causes kernicterus. These isomers are generated during phototherapy or during normal exposure of infants to ambient light. Their presence is generally overlooked or ignored in clinical measurements of circulating bilirubin concentrations and the interpretation of these values. Whether this is justified or clinically important is presently uncertain. However, the presence of isomers may complicate the accurate measurement of free bilirubin concentrations in blood and the use of such values for identifying jaundiced infants at most risk of kernicterus.