In a neonate receiving phototherapy for indirect hyperbilirubinaemia, the nurse notices the baby's skin appears bronze-brown. Total bilirubin is 9 mg/dL and direct bilirubin is 7 mg/dL. What complication has developed and what is the pathophysiology?
- A Bronze baby syndrome; deposition of iron from haemolysis of red blood cells
- B Bronze baby syndrome; photo-oxidation of direct bilirubin and coproporphyrin producing brown pigments that cannot be excreted ✓
- C Carotenaemia; excess carotenoids from phototherapy-induced lipid peroxidation
- D Cholestasis; phototherapy directly damages hepatocytes, impairing bile secretion
Correct answer: B. Bronze baby syndrome; photo-oxidation of direct bilirubin and coproporphyrin producing brown pigments that cannot be excreted
Explanation
Bronze baby syndrome occurs when phototherapy is administered in the presence of conjugated (direct) hyperbilirubinaemia. Photo-oxidation of direct bilirubin and copper-containing coproporphyrins in the skin produces brownish pigments that accumulate because the liver cannot excrete them normally. The skin, serum, and urine turn bronze-brown. Phototherapy is relatively contraindicated when direct bilirubin is elevated. It is NOT iron deposition or carotenaemia.
Reference: Ghai Essential Pediatrics, 10th ed.
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