Bilirubin Photoisomers in Neonatal Jaundice

TL;DR

This paper reviews the chemistry and clinical significance of bilirubin photoisomers in neonatal jaundice and how better understanding could improve phototherapy.

Contribution

The paper provides an updated review and highlights how advances in mass spectrometry can improve understanding of bilirubin photoisomers.

Findings

Bilirubin photoisomers are more hydrophilic and excretable than bilirubin.

Improved mass spectrometry techniques allow better quantification of bilirubin isomers.

Understanding photoisomer formation could optimize phototherapy parameters.

Abstract

Phototherapy is the standard treatment for neonatal hyperbilirubinemia. During phototherapy, the highly lipophilic bilirubin is converted into more hydrophilic photoisomers, which can be more easily excreted from the body. This process typically lowers bilirubin levels to non-harmful concentrations. However, despite decades of research into the formation and role of bilirubin photoisomers, methodological limitations and the compound’s complex biochemistry have hindered comprehensive understanding. This review provides an updated overview of current knowledge on bilirubin photoisomers, including their basic chemistry, analytical quantification, clinical relevance, and future research directions. Improved insight into the mechanism of photoisomer formation and kinetics may inform optimization of phototherapy parameters, including light intensity and wavelength, and offer additional indicators of treatment efficacy beyond total bilirubin concentration. Advances in sensitive and standardized mass spectrometry techniques now enable more accurate measurement of different bilirubin isomers and serve as a first step towards a deeper insight into the clinical relevance of photoisomers.

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