Abstract 1190

Background: Extent of neurologic sequelae in term and near term infants who receive no treatment for neonatal jaundice, is not known. Few infants develop serum bilirubin (SB) levels in excess of 25 mg, and even fewer in excess of 30 mg/dl. Infants are now being discharged home before the peak SB is known and without a tested, practical follow-up protocol for monitoring extent of hyperbilirubinemia. Methods: We analyzed the 7 year outcome for ≥ 2500 BW infants in the 1959-66 CORE Project not treated with exchange transfusion (Ex Tx) or phototherapy (unavailable at the time). Results: Of the 30,287 untreated infants, 156 had a peak SB of 20 to 24.9 mg/dl; 19 a peak SB of 25 to 29.9 mg/dl and one of 30 mg/dl. There was a steady incremental increase in abnormal neurologic ratings from 3.7 to 4.1 to 4.4 to 5.5% in relation to SB strata of <10, 10 to <15, 15 to <20, and ≥20 mg/dl. This pattern differs from that reported by Newman and Klebanoff (1993) whose data base included treated as well as untreated infants. Abnormal ratings in their analysis went from 3.7 to 4.0 to 4.9 to 4.5 % with a peak at SB between 15 and 19.9 mg/dl. This probably reflects the efficacy of Ex Tx (in 49% of infants with SB ≥ 20 mg/dl). Suspect and abnormal neurologic outcome (Susp/Abn) for untreated infants is shown in the (Table) for both males (M) and females (F). The striking and significant gender difference in pattern of increase in Susp/Abn ratings for each bilirubin strata below 20 mg/dl, suggests a greater vulnerability of males to bilirubin neurotoxicity. Conclusions: These data may be useful in estimating risk of bilirubin associated brain damage.

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