Successful treatment of hyperbilirubinemia by monitoring serum unbound bilirubin in an extremely preterm infant with bacterial infection

Background: Bacterial infections and some antibiotics show displacer effects on bilirubin-albumin binding and in-crease unbound bilirubin (UB) but not total bilirubin (TB) in serum. Methods: A case study was conducted to show a successful treatment of hyperbilirubinemia by monitoring UB. Results: In an extremely preterm infant with bloodstream bacterial infection caused by methicillin-resistant coagulase-negative staphylococci, 2 days after high-dose ampicillin and regular-dose amikacin were initiated, UB markedly increased, but TB did not. After vancomycin was substituted, UB decreased immediately with photo-therapy and intravenous albumin infusion. Conclusions: When using antibiotics, the clinicians should be mindful regarding the displacer effect on bilirubin-albumin binding.