Bilirubin benefits

A Learning lesson.

It happened 20 years ago, when we were young.

Those were the days.

The paediatricians were not routinely attending deliveries, either Normal or CS. Obstetricians used to call themselves The Perinatologists. They would give a call only when they feel the newborn is sick, otherwise not. By that time, the baby’s condition would have gone to the point of no return.

A delivery was conducted in a prestigious nursing home of Cuttack. The mother’s stay in the NH was uneventful. No paediatrician was called. Baby was discharged as per routine.

Subsequently, this child developed spasticity, involuntary movements. Now the parents took the kid from neurologist to neurologists. Finally, in the 5th year, the baby went inside the Gantry of a MRI machine at Bangalore. In those days MRI was not available in Odisha. He was rich enough to afford it.

On the MRI screen, the Kern of the baby’s brain lit up like a thousand watt bulb. High intensity signals emanated from from the Sub thalamic region, the Globus Pallidus, Putamen, Substantia Niagra suggesting the bilirubin staining.

Unfortunately, as time passes the MRI signals of Kernicterus only intensify.

KERN means CORE:

Basal ganglia, the limbic system are known as the paleo cortex. The mammalian cortex developed like an umbrella around this core as evolution progressed.

The parents came back home with a diagnosis and sued the Nursing Home for some unknown amount. The Nursing Home settled the issue out of court for some astronomical amount.

Yellow is the colour of Devi Subhadra.

When we are Busy praying to Lord Jagannath and Balabhadra all the time, we should not neglect the yellow faced  Maa Subhadra.

Bilirubin Benefits

Bilirubin is not the villain that interns take it for. It certainly is no Villain.

It is meant to prevent the oxidative stress injury in the Neonates.

Bilirubin and GSH play distinct but complementary roles in protecting cells against oxidative stress injury. Being lipid soluble, Bilirubin might primarily protect cells against Lipid-peroxidation.

SEE LINK BELOW

https://pediatrics.aappublications.org/content/113/6/1776

Nature has made fool proof mechanism to retain whatever bilirubin is produced in the body by a special mechanism called the Entero Hepatic Circulation.

Why?

Bilirubin is the most powerful Antioxidant we know. We accept Vit E  as the vitamin of anti oxidant for life. But Mother Nature uses Bilirubin in the new born period to prevent the Oxidative Stress Injury in neonates.

Entero-Hepatic Circulation of Bilirubin.

Two enzymes are strategically placed to recover whatever bilirubin is excreted into bile. 

1. At the North of the Cycle is UDPGT that conjugates Glucouronic acid to make the bile water soluble. It is excreted in Bile. In the Newborn, at the proximal one of Intestine, the Enzyme Beta Glucuronidase deconjugates it to make fat soluble. The fat soluble bilirubin is absorbed by the lipoprotein layer of intestinal mucosa.
2. Breast Milk also contains the Enzyme Beta Glucuronidase, so that bilirubin pool does not fall short.

Mother Nature has a reason to maintain a bilirubin pool in the neonates, but within limits.