PEDIATRICS Vol. 40 No. 2 August 1967, pp. 196-201
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FOLLOW-UP STUDY OF EXCHANGE TRANSFUSION FOR HYPERBILIRUBINEMIA IN INFANTS IN JAPAN

Toru Ose M.D.1, Tsuneo Tsuruhara M.D.1, Masayoshi Araki M.D.1, Toshiyuki Hanaoka M.D.1, and Ovid B. Bush Jr. M.D.1

1 The Department of Pediatrics, Yodogawa Christian Hospital, and the Osaka Rehabilitation Center, Osaka, Japan

A follow-up study of 157 consecutive patients who had hyperbilirubinemia was undertaken by questionnaire. Parents of 153 patients answered the questionnaire. Complete examination was carried out on 131 (83.4%) patients and, if the 17 who died are included, a 94.2% follow-up was made.

The relationship between the level of the serum bilirubin and the development of cerebral palsy showed that 90% of the patients who had a bilirubin level of 35 mg/100 ml and above either died or had cerebral palsy or physical retardation. Of the 131 cases followed up, there were 17 (13.0%) patients who had definite cerebral palsy, 21 (16.0%) who were physically retarded, and 93 (71.0%) who were normal.

In 129 infants checked for developmental retardation, no instances were found when the serum bilirubin level was below 20 mg/100 ml. There was developmental retardation in 15 patients who had a bilirubin level of 20 mg/100 ml and above. It is felt that this shows there is a definite relation between the height of the bilirubin and the development of cerebral palsy and/or developmental retardation. In this series there were 26 infants with bilirubin levels of 30 mg/100 ml and over. Based on our results, we would suggest that the indication for exchange transfusion should be a total bilirubin level of 20 mg/100 ml for full-term, incompatible infants and for all premature infants; the level for full-term, compatible infants should be 25 mg/100 ml.

Submitted on June 13, 1966
Accepted on March 6, 1967