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BILIRUBIN EXCRETION IN NEWBORN INFANTS: II. Conjugated Bilirubin as a possible Trigger for Bilirubin Excretion

To be excretable, unconjugated bilirubin (UB) has to be coupled to glucuronic acid by the enzyme bilirubin-UDP-glucuronyl transferase (BGT) (EC 2.4.1.17). This conjugated bilirubin (CB) is excreted from the liver cell into the bile by an active process (9, 12). Such an active process is probably also present in the kidneys. The activation time of BE is an important factor in the hyperbilirubinemia found in normal newborn babies (13). The liver bilirubin excretion mechanism has been found partly to depend on hormones (6). The amount of CB within the liver cell may decrease not only because CB is excreted into the bile but also if CB is deconjugated by the enzyme B-glucuronidase (EC 3.2.1.3 1). It has been found that UB functions as a trigger for BGT in the newborn (1,2). In this paper it is shown how CB may trigger its own excretion in normal fullterm infants, in premature infants and in infants suffering from erythroblastosis foetalis. Increasing amounts of CB are supposed to activate its own excretion in a similar way as UB activates BGT. Both these functions have to be activated before the bilirubin is able to escape from the body through the bile or urine.