Concentration of bilirubin in cerebrospinal fluid in newborn infants with jaundice
Exchange transfusion has been the most important and extensively used technique in pediatric practice for the prevention and treatment of kernicterus and traditionally it has been performed on the basis of serum bilirubin level of the patient, 20 mg per cent or above. Recently, however, some investigators (Hardy and Peeples, 1971: Maisels, 1972) insist that the serum bilirubin level alone as a major criterion has little value because kernicterus was observed in some infants
whose serum bilirubin levels were well below 20 mg per cent, only 9.4 mg per cent. (Crosse et al, 1958; Stern and Denton, 1965; Ackerman et al, 1970; Gartner et al,1970)
According to the report by Silberberg and Schutta(1967), the characteristic pathologic changes in the brain tissue were closely related to the concentration of bilirubin and duration of exposure in vitro. Garay and Scremin(1971) investigated with radioactive pigment, bilirubin-14 C in Wistar and Gunn rats and suggested that unconjugated bilirubin was transferred blood to central nervous system through the ventricular compartment.
The present investigation was carried out to evaluate the value of the bilirubin level in cerebrospinal fluid(CSF) as a criterion of exchange transfusion rater than the serum bilirubin level. Preliminarily, the author measured the concentration of bilirubin and total protein in CSF and in serum in newborn infants (30 cases of fullterm babies and 11 cases of premature babies).
Although the levels of bilirubin in serum and in CSF were similar to those of the reported data by Nasralla et al(1958), no positive linear correlation was observed between the bilirubin levels in serum and CSF though a trend to a linear relationship existed. But positive linear correlation was noted between the level of bilirubin and total protein in CSF.