Direct hyperbilirubinemia associated with chloral hydrate administration in the newborn

To test the hypothesis that chloral hydrate can cause direct hyperbilirubinemia (DHB) in the newborn, two retrospective analyses of the medical records of patients admitted to a neonatal intensive care unit during an 18-month period were conducted. In one analysis of 14 newborns who had nonhemolytic DHB, 10 did not have an identified cause of DHB, and all 10 had received chloral hydrate. In the second retrospective study, all newborns who received chloral hydrate were divided into groups according to whether or not DHB had developed. The newborns with DHB, compared with those without DHB, had received a higher total accumulative dose of chloral hydrate (1035 +/- 286 vs 183 +/- 33 mg/kg [+/- 1 SEM], respectively). In the patients with DHB, the direct serum bilirubin levels increased 6.8 +/- 0.8 days after the chloral hydrate administration began and resolved after the chloral hydrate was discontinued or markedly decreased. These data support the hypothesis that prolonged use of chloral hydrate in newborns can be associated with DHB.