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Neonatal bilirubin production, reflected by carboxyhaemoglobin concentrations, in Down’s syndrome
  1. Michael Kaplana,b,
  2. Hendrik J Vreman,
  3. Cathy Hammermana,b,
  4. David K Stevensonc
  1. aDepartment of Neonatology, Shaare Zedek Medical Center, bFaculty of Medicine of the Hebrew University Jerusalem Israel, cDepartment of Pediatrics Stanford University Medical Center Stanford California, USA
  1. Dr Michael Kaplan Department of Neonatology Shaare Zedek Medical Center Box 3235 Jerusalem 91031 Israel. Email: kaplan{at}


AIM To determine whether increased bilirubin production, reflected by blood carboxyhaemoglobin (COHb) values, is responsible for hyperbilirubinaemia in cases of Down’s syndrome with no obvious cause for excessive jaundice.

METHODS Blood was sampled on the third day of life for COHb, total haemoglobin (tHb), and serum total bilirubin, from 19 consecutively born neonates with Down’s syndrome (a subset of 34 term babies), who had developed hyperbilirubinaemia (serum bilirubin ⩾ 256 μmol), and from 32 term controls. COHb, measured by gas chromatography, was corrected for inspired CO (COHbc) and expressed as a percentage of tHb.

RESULTS Significantly more of the Down’s syndrome subset developed hyperbilirubinaemia than the controls (10/19 (52%) vs 7/32 (22%), relative risk 2.4, 95% confidence intervals (CI) 1.10 to 5.26). Third day serum bilirubin values (mean (SD)) were higher in the Down’s syndrome neonates than in controls (214 +– 63 μmol/lvs 172 +– 54 μmol/l, respectively, p=0.015). Mean (SD) COHbc values were significantly higher in the Down’s syndrome neonates than in controls (0.92 +– 0.24%vs 0.63 +– 0.17%; p<0.0001). However, Down’s syndrome neonates who became hyperbilirubinaemic had similar COHbc values to those who did not (0.87 +– 0.26% and 0.95 +– 0.23%, respectively). These values contrast with those of the controls, in whom a significant increase in COHbc was associated with hyperbilirubinaemia (0.74 +– 0.15% vs0.60 +– 0.16%, respectively; p<0.05). tHb values were similar in both groups.

CONCLUSIONS Down’s syndrome neonates had a greater risk of hyperbilirubinaemia, and higher COHbc values, than controls. However, excessive bilirubin production could not be exclusively responsible for the hyperbilirubinaemia. By inference, decreased bilirubin elimination probably plays a greater part in its pathogenesis than in controls. Down’s syndrome neonates may have abnormal erythropoiesis, leading to increased haem turnover.

  • Down’s syndrome
  • carboxyhaemoglobin
  • carbon monoxide
  • jaundice
  • bilirubin production
  • haemolysis

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