To the Editor.—

Although the hazards related to postnatal hyperbilirubinemia are well described, less is known about prenatal exposure to high concentrations of bilirubin, particularly in its conjugated form. This issue was raised while we were anticipating the birth of an infant to a mother affected by end-stage bile duct adenocarcinoma. She had developed chronic bilirubin concentrations up to 26 mg/dL, almost entirely in its direct form. She delivered a 33-week, 2440-g, appropriate-for-gestational-age male infant with a negligible serum bilirubin level at birth despite the intense yellow staining of the cord, the amniotic fluid, and the vernix. Later, the neonate developed common unconjugated hyperbilirubinemia treated briefly with phototherapy and was discharged without significant problems. We believe that this rare, but not exceptional, situation underlines the clinical importance of the placenta as an efficient barrier to the maternal-fetal transfer of conjugated bilirubin.

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