[The treatment of severe neonatal icterus]

The aetiopathogenesis of icterus is briefly examined and stress is laid on the immaturity of the neonatal and particularly of the immature infanti liver. A limit is then set between paraphysiological and serious icterus and the symptoms of neonatal hyperbilirubinaemia with or without nuclear icterus are recalled. Attention is drawn to the debated problem of the bilirubin threshold value and the different and often conflicting views of the various schools are cited. Caution is urged since the nervous damage must be evaluated even over periods of years. The techniques employed in the determination of bilirubin values are then discussed and the associated difficulty of settling the threshold level is noted; standardisation of methods is to be hoped for and reference is made to personal experience of considerable differences between venous and capillary blood when the latter is expressed. Treatment of the disease has been attempted with various substances, some (cortisones, albumin) with notable others (triiodothyronine, polyvinylpyrrolidone) with little success; the use of anti-D sera and immunoglobulins in Rh-negative mothers as a means of prevention of neonatal jaundice is also noted. Personal experience (113 subjects) with phototherapy is resorted and the complete absence of short or long term damage is noted. 3 1/2 years experience with exsanguinotransfusion is also presented: 57 cases (0.7% of births; mortality rate 3.5%). In 40% of these cases bilirubin values had passed the 20 mg % threshold (max. 36%); only one patient presented early and late signs of damage.