The biology of bilirubin production: overview of detection and inhibition

May 1, 2021Pediatric MedicineOpen Access

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Key Points

To summarize the biological mechanisms of bilirubin formation and evaluate current diagnostic and therapeutic strategies for neonatal hyperbilirubinemia.
Narrative synthesis of red blood cell turnover and heme catabolism pathways.
Review of clinical detection modalities, including total serum bilirubin and carbon monoxide production metrics.
Assessment of standard therapeutic approaches, including narrow-band blue phototherapy and exchange transfusion.
Heme oxygenase catalyzes heme degradation to yield equimolar amounts of carbon monoxide, iron, and bilirubin, allowing carbon monoxide production rates to serve as an index of bilirubin generation.
Excessive bilirubin production from hemolysis or impaired conjugation via UGT1A1 deficiency drives severe hyperbilirubinemia.
Unmanaged hyperbilirubinemia poses a direct risk for bilirubin-induced neurologic dysfunction, requiring early detection and intervention with phototherapy or exchange transfusion.

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Narrative review outlines mechanisms of bilirubin production and detection in newborns, highlighting therapeutic approaches to prevent neurotoxicity.

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Stevenson et al. (2021) studied this question.

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