Estimation and Clinical Significance of Bilirubin Binding Status

  • Timos Valaes


The association between hyperbilirubinemia and neurotoxcity was established by epidemiologic data in the early fifties 1,2 and was strengthened by the successful prevention of kernicterus following control of hyperbilirubinemia by exchange transfusion and hototherapy. The purists have argued that in the absence of randomized clinical trials a causal relationship was never proven. The difficulty in deciding when an epidemiologically established association should be considered proof of a causal relationship is well known from the story of tobacco smoking and lung cancer. In both associations the distinction between legitimate doubts and unreasonable demands for the perfect proof is difficult to make. An additional problem is the lack of a generally accepted pathogenetic mechanism for bilirubin*(BR) neurotoxicity3, which invites the search for alternative explanations.


Neonatal Intensive Care Unit Exchange Transfusion Neonatal Jaundice Central Pontine Myelinolysis Plasma Bilirubin 


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Copyright information

© Springer Science+Business Media New York 1984

Authors and Affiliations

  • Timos Valaes
    • 1
  1. 1.Department of PediatricsTufts-New England Medical Center HospitalBostonUSA

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