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Neurodevelopmental outcome at 1 year in Zimbabwean neonates with extreme hyperbilirubinaemia
1Children's Rehabilitation Unit, Mpilo Central Hospital, Bulawayo, Zimbabwe. mjbwolf@knoware.nl
Insights
High total serum bilirubin (TSB) in neonates is linked to abnormal neurodevelopmental outcomes. Specifically, 26% of infants with TSB > 400 micromol/l showed developmental delays, and 12% developed cerebral palsy.
Area of Science:
- Neonatal Medicine
- Neurodevelopmental Pediatrics
- Public Health
Background:
- Neonatal jaundice, indicated by elevated total serum bilirubin (TSB), is a common condition.
- Severe hyperbilirubinemia is a known risk factor for adverse neurodevelopmental outcomes, including kernicterus.
Purpose of the Study:
- To assess the neurodevelopmental impact of high TSB levels (> 400 micromol/l) in Zimbabwean neonates at one year of age.
- To determine the association between TSB and neurodevelopmental outcomes using the Bayley Scales of Infant Development (BSID).
Main Methods:
- A cohort of 50 singleton Zimbabwean neonates was studied.
- TSB levels were measured, and neurodevelopmental outcomes were assessed at corrected age using the BSID.
- Data analysis focused on infants with TSB > 400 micromol/l.
Main Results:
- Of 43 infants with TSB > 400 micromol/l, 26% scored abnormally on the BSID at one year.
- 12% of these infants developed the choreoathetoid type of cerebral palsy.
- TSB was not associated with birth weight or gestational age.
Conclusions:
- Neonates with TSB between 400-500 micromol/l who had abnormal BSID scores were often preterm or had hemolytic disease.
- Term infants without hemolysis and with TSB levels between 400-500 micromol/l demonstrated normal neurodevelopmental outcomes at one year.
Unlabelled:
The study concentrates on estimating the magnitude of the effect of a single risk factor, maximum total serum bilirubin (TSB) in excess of 400 micromol/l (23.4 mg/dl), on the neurodevelopmental outcome of 50, singleton, Zimbabwean neonates at 1 year of age. At 1 year corrected age the Bayley Scales of Infant Development (BSID) was administered. Two infants died and five were lost to follow up. TSB was neither associated with birth weight nor with gestational age. Of 43 infants with a TSB > 400 micromol/l (23.4 mg/dl),11(26%) scored abnormal on the BSID at 1 year of age and 5 (12%) infants developed the choreoathetoid type of cerebral palsy.
Conclusion:
Infants with bilirubin levels between 400 and 500 micromol/l (23.4 and 29.2 mg/dl) who scored abnormal or suspect on the Bayley Scales of Infant Development were preterm or had haemolytic disease. All term infants without haemolysis and with bilirubin levels between 400 and 500 micromol/l (23.4 mg/dl-29.2 mg/dl) were normal at 1 year of age.