Long-term follow-up of indirect hyperbilirabinemia in full-term Turkish infants

objective. This retrospective follow-up study was performed to evaluate the suitability of the recently reported exchange transfusion limits (serum indirect bilirubin level of 428-496 mu mol/l, 25-29 mg/dl) for Turkey. Material and methods: The study groups totalled 102 children, 8-13 years of age, who had been born at term with birthweights greater than 3000 g and had been treated for indirect hyperbilirubinemia during their newborn period: the control group consisted of 27 children of the same age-group without indirect hyperbilirubinemia. Children were grouped according to their maximum serum indirect bilirubin levels and direct Coombs' test results. Physical and neurological examinations, visual and brainstem auditory evoked potentials and the Wechsler Intelligence Scale for Children-Revised for Turkish Children were performed. Results: There was no difference between the groups with regard io mean visual and brainstem auditory evoked potential latencies. Children whose direct Coombs' tests were positive had significantly lower IQ scores and more prominent neurological abnormalities (p < 0.05). IQ scores and prominent neurological abnormalities did not differ among the other groups. Nine children had prominent neurological abnormalities associated with abnormal brainstem auditory evoked potentials. An important risk factor was the duration that the infant's serum indirect bilirubin level remained greater than 342 mu mol/l (20 mg/dl). Conclusion: The current limit of 342 mu mol/l should continue to be used for infants whose direct Coombs' tests are positive in our country. Until better criteria for exchange transfusion other than the indirect bilirubin level are established, the current limits should also still be followed for infants whose direct Coombs' tests are negative in Turkey, where regular neonatal follow-up examinations are not satisfactory.