Endotoxemia and hyperbilirubinemia in the neonate
P. K. Goldberg, P. J. Kozinn, B. Kodsi, R. Lewitis, B. Ackerman, L. Aschenbrand and F. Feldman
One hundred twenty-five neonates with varying serum bilirubin levels were
tested for endotoxin by the limulus amebocyte lysate (LAL) test. Neither
infection nor hemolytic disease was a contributing factor to the bilirubin
levels. As the serum bilirubin level rose, positive LAL tests increased in
frequency until the LAL test attained 100% at a level of 13 mg/dL.
Bilirubin at different concentrations did not elicit positive LAL tests in
plasma or normal saline in vitro. The LAL test was positive in urine
obtained by suprapubic aspiration in 50% of neonates with positive serum
LAL tests. Although bilirubin and endotoxin are cleared independently by
hepatic cells with different functions, a striking relationship is evident
between the endotoxin and bilirubin levels in the neonate. Immaturity of
physiological liver functions in the neonate plays an important role. The
LAL test cannot be used as an indicator of Gram-negative sepsis in neonates
with unconjugated hyperbilirubinemia.
