Neurodevelopmental outcome at 6 months of age of full-term neonates with hyperbilirubinemia necessitating exchange transfusion

Abstract

Background

Bilirubin neurotoxicity involves a spectrum of varying severity that could result in adverse long-term sequelae.

Aims

To compare the neurodevelopmental outcome of full-term neonates who underwent exchange transfusion with those who did not.

Study design

A retrospective cohort study.

Subjects

This study included a retrospective review of records of sixty neonates who were matched in admission ages and serum bilirubin levels and the comparison groups were those who received an exchange transfusion (n = 30) versus those where exchange transfusion was planned, but the bilirubin levels dropped sufficiently during the period where the exchange blood was being prepared (n = 30). History, clinical examination, and laboratory investigations were documented.

Outcome measures

Neurodevelopmental outcome, at 6 months of age, using Bayley scales of infant development was assessed.

Results

The exchange group had statistically significant lower cognitive scores (p-value 0.005). The higher the rate of bilirubin decline, the better the language and motor scores in the phototherapy group (p-values 0.020 and 0.024 respectively). Infants with longer duration to exchange transfusion had lower cognitive, language, and motor scores (p-values 0.01, 0.001, and 0.003 respectively).

Conclusions

Slower rates of bilirubin decline and longer duration before intervention increase the chances of adverse neurodevelopmental outcomes.