SB Amin. J Pediatr 2023; 254: 91-95. Bilirubin-Displacing Effect of Ceftriaxone in Infants With Unconjugated Hyperbilirubinemia Born at Term

This prospective study with 27 term infants (<7 days) with mild unconjugated hyperbilirubinemia (total bilirubin 6-12 mg/dL) (to convert to micromol/L multiple by 17.1) and with sepsis. Free bilirubin concentrations were measured by the peroxidase method using a UB analyzer and a Zone Fluidics device before (baseline) and 15 minutes after (follow-up) IV ceftriaxone administration on postnatal days 4 to 6.

Key findings:

• The mean free bilirubin (μg/dL) at follow-up was not different from that at baseline when measured by the UB analyzer (P = .78). The mean free bilirubin was significantly lower at follow-up compared with baseline when measured by the Zone Fluidics device (P = .02). The ratio of a free bilirubin with and without ceftriaxone, an index of displacing effect, was 1.02 (95% CI 0.89-1.14) using the UB analyzer and 0.58 (95% CI 0.30-0.86) using the Zone Fluidics device.

Ceftriaxone has been considered contraindicated in the presence of neonatal unconjugated hyperbilirubinemia due to concern of bilirubin displacement from albumin, resulting in elevated serum free bilirubin (& risk of kernicterus). However, “most of the evidence for the bilirubin-displacing effect of IV ceftriaxone has been derived from in vitro studies.”

My take: This study indicates that there is no significant effect of ceftriaxone in increasing free bilirubin in term infants with mild unconjugated hyperbilirubin

Related blog posts:

• Genetic Diseases and Newborn Unconjugated Hyperbilirubinemia
• Understanding Breast Milk Jaundice
• Unbound Bilirubin and Prematurity

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