Treated Jaundice Not Likely to Leave Lasting Effects

Study finds even high levels of bilirubin don't cause neurological problems with proper care

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By Serena Gordon
HealthDay Reporter

WEDNESDAY, May 3, 2006 (HealthDay News) -- Parents of infants who've been jaundiced can breathe a sigh of relief because a new study confirms what doctors have suspected all along -- as long as the baby receives proper treatment, there should be no lasting neurological damage.

There had been some concern because extremely high levels of bilirubin have been known to cause brain damage. Bilirubin is a byproduct of red blood cell breakdown that causes the skin and eyes to yellow in jaundice, and high levels are referred to as hyperbilirubinemia. It wasn't clear whether lower, though still elevated, levels of bilirubin, would cause any long-term problems.

"Parents of children who had hyperbilirubinemia can be reassured," said study author Dr. Thomas Newman, a professor of epidemiology and biostatistics and pediatrics at the University of California, San Francisco. "They may have nagging worry that because the baby has been jaundiced that they might not be OK. But the outcome for most babies is very good. They don't have to worry about some subtle neurological problem," he added.

The findings appear in the May 4 issue of the New England Journal of Medicine.

Newman said that jaundice is quite common, and occurs in about 60 percent of all babies. But jaundice, which is really just the medical term for the yellowing of the eyes and skin caused by high bilirubin levels, begins to occur at levels between 5 mg/Dl and 10 mg/Dl. The current study focused on very high levels of bilirubin, those above 25 mg/Dl. Such high levels occur in about one in 700 babies, according to Newman. Levels above 30 mg/Dl are the most likely to cause serious problems, such as kernicterus, which can cause brain damage, hearing loss and cerebral palsy, according to the study.

Treatments for high bilirubin levels include making sure the baby is well-hydrated, phototherapy, and, for more serious cases, exchange transfusion. Proper hydration helps the body remove bilirubin through the stool. Phototherapy is placing the baby under an artificial light source. This helps break down the bilirubin that is close to the skin. Exchange transfusion is a procedure that exchanges the baby's blood for fresh donated blood.

The current study included 140 newborns with bilirubin levels of at least 25 mg/Dl, and 419 randomly selected healthy controls born in Kaiser Permanente hospitals in northern California between 1995 and 1998. Ten of the babies had bilirubin levels above 30 mg/DL.

One hundred and thirty-six youngsters received phototherapy, and five were given exchange transfusion. Some children received both treatments, and two children received no treatment because their hyperbilirubinemia resolved quickly on its own.

The researchers followed the children for up to five years. They measured IQ scores, interviewed parents, and conducted neurological assessments.

They found no significant differences between the children who had hyperbilirubinemia and the children who had been healthy as newborns.

"This is the largest prospective, blinded study of the neurodevelopmental outcome of bilirubin levels over 25 mg/DL, and their findings provide some assurance that these levels aren't placing infants at inordinate risk," said Dr. Jon Watchko, a professor of pediatrics and senior scientist at the University of Pittsburgh School of Medicine and the Magee-Women's Research Institute. Watchko also wrote an accompanying editorial in the same issue of the journal.

Both Watchko and Newman said there isn't much that women can do to try to prevent hyperbilirubinemia, but that all new parents should carefully look for jaundice in the baby's first few days of life.

"One of the keys is to keep an eye out for jaundice in babies that have been discharged home from the hospital because it usually evolves after discharge," explained Watchko.

Breast-fed babies are at a higher risk of jaundice, particularly if there are feeding problems, because they may not be getting enough fluid. "In mothers who are breast-feeding, which is strongly encouraged by the pediatric community, make sure the milk is coming in and that you're getting appropriate lactation support," said Watchko.

"While most new parents don't start out that worried about this, it's important to keep your prenatal appointments and then have the baby seen during the first few days after birth," said Newman.

Catching jaundice early is key. "We didn't really find any adverse effects from having high bilirubin when it was treated properly," Newman said.

More information

To learn more about jaundice in newborns, go to the National Library of Medicine.

SOURCES: Thomas Newman, M.D., M.P.H., professor, epidemiology and biostatistics and pediatrics, University of California, San Francisco; Jon Watchko, M.D., professor, pediatrics, and senior scientist, University of Pittsburgh School of Medicine and Magee-Women's Research Institute, Pittsburgh; May 4, 2006, New England Journal of Medicine

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