The natural history of direct hyperbilirubinemia associated with extracorporeal membrane oxygenation
M. C. Walsh-Sukys, D. J. Cornell and E. K. Stork
Rainbow Babies and Childrens Hospital, Case Western Reserve University, Cleveland, Ohio 44106.
OBJECTIVE--To determine the incidence and natural history of direct
hyperbilirubinemia in neonates treated with extracorporeal membrane
oxygenation. DESIGN--A prospective series of patients. SETTING--A level 3
neonatal intensive care unit and center for extracorporeal membrane
oxygenation in Ohio. PARTICIPANTS--Sixty-seven consecutive patients treated
with extracorporeal membrane oxygenation in 33 months. INTERVENTION--None.
MEASUREMENTS/RESULTS--Twenty-six (39%) developed direct hyperbilirubinemia.
In 14 (54%), bilirubin levels were mildly elevated and occurred only during
extracorporeal membrane oxygenation therapy. Levels were more severely
elevated in the remaining 12 patients (46 +/- 10 mumol/L [2.7 +/- 0.6
mg/dL] vs 159 +/- 101 mumol/L [9.3 +/- 5.9 mg/dL], P less than .0001).
Duration and severity of hyperbilirubinemia were correlated.
Hyperbilirubinemia resolved in all patients by 9 weeks after extracorporeal
membrane oxygenation therapy. No structural abnormalities or infectious
agents were identified as causes. Aluminum levels were evaluated for 40
patients, were not in the toxic range, and did not correlate with
hyperbilirubinemia. Multiple linear regression analysis suggested that
hyperbilirubinemia in these cases resulted from interaction of injuries,
with the primary contributor being hemolysis during extracorporeal membrane
oxygenation. CONCLUSIONS--Direct hyperbilirubinemia occurs frequently in
patients treated with extracorporeal membrane oxygenation and may be
severe. However, direct hyperbilirubinemia typically resolves without
short-term sequelae. Hemolysis may be an important contributing factor.
