The effect of moderate non-hemolytic jaundice and phototherapy on newborn behavior

To study the effects of moderate non-hemolytic jaundice and phototherapy (PT) on newborn behavior, initially 29 full-term infants with serum bilirubin (SB) 12-15 mg/dl were randomly assigned to PT (n = 14) or non-PT (n = 15) group. PT was done until SB less than 12 mg/dl. One infant in the PT group was excluded because of G-6-PD deficiency and evidence of hemolysis. Four infants in the non-PT group were excluded because their serum bilirubin concentrations finally exceeded 15 mg/dl and they were put on phototherapy for ethical concern. Two more infants were then added to the non-PT group to make a total number of 13. Additional 14 infants with serum bilirubin levels less than 12 mg/dl were studied as controls. Neonatal Behavioral Assessment Scales (NBAS) were performed 4 times: just before PT, right after termination of PT, 24 hrs after termination of PT and at 2 wks of age in PT group, and at comparable ages with the non-PT and control groups. The course of jaundice was measured in terms of SB levels at entry into study, peak SB levels, duration from entry into study to the time when SB levels dropped below 12 mg/dl and age when SB levels dropped below 12 mg/dl. The values did not differ significantly between the PT and non-PT groups. Therefore, phototherapy did not change the clinical course of jaundice in the majority of infants with bilirubin levels between 12 and 15 mg/dl. The 7 cluster scores of 1st NBAS did not differ significantly among the 3 groups of infants. On the 2nd and 3rd examinations, the infants in the PT group performed poorer in some of the orientation items than the infants in the non-PT and control groups (p less than 0.05) whereas the non-PT groups showed similar performance as the control group. At 2 wks of age, no significant differences of the NBAS scores were found in 3 groups. We conclude that moderate non-hemolytic jaundice (serum bilirubin 12-15 mg/dl) does not affect the behavior of full-term infants in this study. Phototherapy has some short-term adverse effects on visual, auditory orientation and alertness of the infants which may impair infant-caregiver interaction.