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GLUCOSE INFUSION FOR THE PREVENTION OF BILIRUBIN TOXICITY IN THE NEONATE: THE ROLE OF FREE FATTY ACIDS (FFA)

The jaundiced neonate is at risk to bilirubin toxicity if its serum albumin has a diminished capacity to further bind bilirubin as indicated by a high saturation index (SI) of ≥ 8% (J Pediatr 76:12, 1970). This study reports 8 jaundiced infants (T. Bil = 13.8 ± 1.8 mg%) withy high SI (8.4 ± 0.8%) and no hemolytic disease or drug intake. The infants were 2–4 days old and were either feeding poorly on formula or insufficiently on the breast with glucose water supplement. Glucose infusion was given at a rate of 1 g/kg/h for 2 hours. After the infusion, there was a significant fall (ρ < 0.05) in the SI (Δ = -4.6%) and total serum FFA (Δ = -3.4 mEq/L). These changes were not secondary to simple dilution since there was no associated significant fall (ρ > 0.10) in the bilirubin (Δ = 1.1 mg%) or serum protein (Δ = -0.15 g%) concentrations.The composition of the serum FFA was further analyzed by gas-liquid chromatography and it was observed that the SI was predominantly influenced by the unsaturated FFA level. The fall in the SI (Δ = -4.6%) correlated significantly (ρ < 0.05) with the fall in concentration of palmitoleic (Δ = -1.13 mEq/L, r=0.82) and oleic (Δ =-1.48 mEq/L, r=0.68) acids but not with lauric, myristic, plamitric or stearic acids (ρ > 0.10).CONCLUSION:Our study indicates that the risk to bilirubin toxicity in any jaundiced infant who is feeding insufficiently should be immediately identified since treatment by, glucose is both simple and effective. In particular, the jaundiced infant is at risk if breast fed prior to the normal flow of mother's milk. Since all the breast fed infants in our series who had high SI were being supplemented with oral glucose water after each breast feeding, our findings further indicate that the measure may not be effective in reducing the risk to bilirubin toxicity.