HYPERBILIRUBINEMIA

HYPERBILIRUBINEMIA 

Background

Clinicians caring for infants whose parents are Jehovah's Witnesses face initiating legal action to perform exchange transfusions for severe hyperbilirubinemia when intensive phototherapy fails. Whether Snmesoporphyrin (SnMP), a potent inhibitor of bilirubin production, could be used successfully in 2 Jehovah's Witness infants with hemolytic disease of the newborn who needed exchange transfusions for severe hyperbilirubinemia was determined.

Methods and Outcomes

The infants were a preterm boy, born at 35 weeks' gestation with a birth weight of 2790 g, and a girl born at term weighing 4140 g. In both infants, intensive phototherapy failed to resolve hyperbilirubinemia. The parents of both infants, being Jehovah's Witnesses, refused exchange transfusions. Thus, SnMP was given, in a single IM dose of 6 mol/kg birth weight, when exchange transfusion would have been initiated. Plasma bilirubin levels were monitored closely thereafter. In both infants, SnMP stopped the progression of hyperbilirubinemia.

Conclusions

Inhibiting bilirubin production with SnMP can be effective alternative to exchange transfusion in the management of severe newborn jaundice that has not responded to intensive phototherapy, as demonstreted by its successful use in these 2 infants of Jehovah's Witness parents who would not permit exchange transfusions.