Hyperbilirubinemia in premature infants: A follow-up study

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Summary

Serial determinations of serum bilirubin were made during the first week of life of 100 premature infants. None of these patients had any demonstrable evidence of infection or isoimmunization. Those who developed hyperbilirubinemia were considered to have “physiologic jaundice” and at that time (1953) no treatment was instituted.

Eight infants died, 2 of whom had kernicterus. Their bilirubin levels and been greater than 20 mg. per 100 ml. The remaining 6, who died of other causes, had levels below 20.

Of the surviving infants, nore had neuromuscular abnormalities on discharge from the nursery. Of a group of 49 patients examined when they were 1 year or more of age, 5 had neuromuscular abnormalities highly suggestive of kernicterus. All of these patients had had serum bilirubin levels of more than 20 mg. per 100 ml. during the neonatal period.

The relationship of kernicterus to factors of birth weight and condition of the patients at birth was not so distinet and clear-cut as the relationship to hyperbilirubinemia.

The difficulty of making a clinical diagnosis of kernicterus in the first weeks of life was emphasized and makes the observation of patients for a number of years to detect the true incidence of the disease essential.

Exchange transfusions are indicated for all infants with hyperbuilirubinemia in the newborn period if it is evident that the serum bilirubin levels will exceed 20 mg. per 100 ml.

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