Long term follow-up of the term neonates with severe indirect hyperbilirubinemia; should the exchange transfusion limits be changed in Turkey

Conflicting reports have led to confusion about the optimal management of jaundice in otherwise healthy term infants. The purpose of this study was to evaluate nonhemolytic term infants with marked hyperbilirubinemia treated by only phototherapy for evidence of bilirubin toxicity at 2 to 6 years of age and also to determine the suitability of the exchange transfusion limits recently reported by the American Academy of Pediatrics for the Turkish children. The study group included a total of 30 children with an age range of 2-6 years who developed marked hyperbilirubinemia (20-24 mg/dl) during their newborn period (gestational age >37 wk, birth weight >2500 g) and treated without exchange transfusion because intensive phototherapy, instituted during the preparations for exchange transfusion, was successful in decreasing their serum bilirubin levels. The control group consisted of 30 children of the same age group without indirect hyperbilirubinemia in their newborn period. Physical and neurological examinations, brainstem auditory evoked potentials and the developmental tests for Turkish Children were performed in both the study and control children. There was no difference between the groups with regard to mean brainstem auditory evoked potential latencies and developmental quotients. None of the infants had hearing loss, developmental delay or abnormal neurologic findings. These results suggest that successful intensive phototerapy without exchange transfusion in otherwise healthy term newborn infants with marked hyperbilirubinemia (20-24 mg/dl) might not increase the risk of bilirubin brain injury. Conventional limit of 20 mg/dl could be changed to 22-24 mg/dl for these infants in Turkey. These limits, however, address only healthy term infants who do not have hemolytic disease, and there is not available data to conclude the safety of higher levels in our population. Key words: neonatal jaundice, exchange transfusion, bilirubin toxicity, development, brainstem auditory evoked potentials