A Follow-up Study of Newborns who had Exchange Blood Transfusion for Hyperbilirubinemia

Yoon, Young Soo; Park, Seung Joon; Kim, Ki Bok

Abstract

A follow up study was made of 59 cases of neonatal hyperbilirubinemia receving blood exchange transfusion at Kwangju Christian Hospital from early 1976 to early 1979, with the following results. 1. 42patients(71.2%) returned for followup: 12 patients(20.3%) did not return; and 5 patients(8.5%) had died. 2. Of those returning, developmental status was studied by D.D.S.T. 38 patients(90.5%) had normal development , 3(7.1%) were retarded, and 1(2.4%) was questionable. 3. There was no retardation among patients exchange-Transfused at the age of 5 days or less, except for one patients with severe dehydration. All the other retarded or dying patients were over 5 days at the time of exchange transfusion. 4. Serum bilirubin level was above 27 mg% in all retarded patients . Of the 5 patients dying, 3 had serum bilirubin levels of over 40mg%, one with S.B. of 25mg% had BET at 10 days of age, and one died of necrotizing enterocolitis without evidence of kernicterus. 5. In patients with normal development, 23 were male, and 15 were female. All females had normal development, whereas all four babies with retardation were male. 6. Because S.B. remained over 25mg%, three patients underwent a second BET, with good results. 7. ABO incompatibility was etiologically responsible in 23 cases (55.9%), followed by idiopathic hyperbilirubinemia in 16 cases (27.4%), Other causes of hyperbilirubinemia were infection, respiratory distress syndrome, immune neonatal thrombocytopenia, enclosed hemorrhage, small-for-date infant, etc. 8. Mean values with standard errors of pre BET serum bilirubin level were as follows. Normal development group: 28.10.69mg% Retarded development group: 30.21.15mg% There was a tendency toward higher S.B. levels in retarded development group. 9. Nine patients who had early signs of kernicterus on admission, developed normally after BET, but those patients , shown later to be retarded, had only transient improvement of early signs of kernicterus at the time of discharge. 10. Thirty-three patients had siblings, among whom 8 also had history of hyperbilirubinemia or mental retardation due to kernicterus, or had undergone blood exchange transfusion. All of the were cases of ABO incompatibility. 11. Motor distrubance was the predominant handicap in all 4 cases of typical cerebral palsy, but no speech disturbance or hearing loss was seen. Choreoathetosis was evident in two patients over 3 years of age, but it was not possible to classify the cerebral palsy in two patients less than 1 1/2years of age.