Bilirubin and certain drugs may compete for binding sites on albumin in the blood. In a neonate with hyperbilirubinemia an increase in the concentration of unbound bilirubin may increase the risk for kernicterus.
Factors affecting the amount of bilirubin displaced:
(1) concentration of drugs competing for the binding sites on albumin
(2) affinity of the drugs for the binding sites relative to the affinity shown by bilirubin
(3) decreased serum albumin
(4) synergistic binding by drug combinations (a combination of drugs may exert a greater effect than either drug alone)
Sources of implicated drugs:
(1) drugs given to mother shortly before delivery
(2) drugs given to a mother who is breast feeding
(3) drugs given to the neonate
where:
• Unbound bilirubin is distinct from unconjugated bilirubin.
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