Long‐term follow‐up of otherwise healthy term infants with marked hyperbilirubinaemia: should the limits of exchange transfusion be changed in Turkey?

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Aim: To evaluate prospectively non‐haemolytic term infants with marked hyperbilirubinaemia treated by phototherapy only for evidence of bilirubin toxicity at 2–6 y of age, and to determine the suitability for Turkish children of the exchange transfusion limits recently reported by the American Academy of Pediatrics. Methods: The study group included a total of 30 children, aged 2–6 y, who had developed marked hyperbilirubinaemia (20–24 mg dl−1, 342–410 μmol l−1) during the newborn period (gestational age >37wk, birthweight >2500 g) and were 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 clinical jaundice in the newborn period. Physical and neurological examinations, brainstem auditory‐evoked potentials (BAEPs) and developmental tests for Turkish children were performed in both the study and control children. Results: There was no difference between the groups with regard to mean BAEP latencies and developmental scores. None of the infants had hearing loss, developmental delay or abnormal neurological findings. Conclusion: The results suggest that successful intensive phototherapy without exchange transfusion in otherwise healthy term newborn infants with marked hyperbilirubinaemia (20–24 mg dl−1, 342–410 μmol l−1) might not increase the risk of bilirubin brain injury and that the conventional limit of 20 mg dl−1 (342 μmol l−1) could be changed to 22–24 mg dl−1 (376–410 μmol l−1) for healthy term infants in Turkey. These limits, however, address only infants who do not have haemolytic disease, and the data are not sufficient to draw conclusions on the safety of even higher bilirubin levels (i.e. >24 mg dl−1, 410 μmol l−1) in this population.