Acute bilirubin encephalopathy in healthy term neonates requiring exchange transfusion

ABSTRACT

There is a growing concern about an increasing bilirubin-induced neurological dysfunction [BIND] in healthy term neonates with no evidence of hemolytic disease or other risk factors. This study was done to determine the incidence of BIND in otherwise healthy, breast-fed newborn term infants without hemolysis who underwent exchange transfusion. This study was conducted in jaundiced newborn infants <7 days of age, from April 2005 to April 2007. The infants were selected if they underwent double volume exchange transfusion [ET] in the first week of life. Babies with any condition affecting neurodevelopment were excluded. Data obtained by clinical findings, and predetermined laboratory tests, and questionnaires. Infants with suspected bilirubin associated brain damage were reviewed according to findings. During the 2- year period, 140 term newborn infants underwent ET; 7 of these patients were excluded; 133 patients were followed and 69 patients were selected without BIND, and 64 were assigned to the group with BIND. This study showed that 48% of jaundiced newborn infants who underwent exchange transfusion, manifested bilirubin induced neurological dysfunction. Unsuccessful breast feeding was found to be a statistically significant risk factor for BIND [p0.001], sex, route of delivery, family history of jaundice, mean maternal age, number of gravity, parity, abortion, and babies mean admission age ,mean age at jaundice presentation, amount of weight loss, mean total serum bilirubin level were not found to significantly influence BIND. Of the healthy term neonates who developed jaundice within the first week of life, 48% without hemolysis who underwent exchange transfusion demonstrated BIND. It is still not clear whether acute bilirubin encephalopathy affects neurodevelopmental outcome or not. Unsuccessful breast feeding was found to be a statistically significant risk factor