PEDIATRICS Vol. 88 No. 4 October 1991, pp. 828-833
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Neonatal Hyperbilirubinemia and Physical and Cognitive Performance at 17 Years of Age

Daniel S. Seidman MD1, Ido Paz BMSc2, David K. Stevenson MD3, Arie Laor MD, MSc4, Yehuda L. Danon MD5, and Rena Gale MD2

1 From the Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel
2 From the Department of Neonatology, Bikur Cholim Hospital, Jerusalem, Israel
3 From the Department of Pediatrics, Stanford University School of Medicine, Stanford, California
4 From the Medical Statistics Branch, Israel Defence Forces Corps
5 From the Division of Pediatric Immunology, Beleinson Medical Center, Sackler School of Medicine, Tel-Aviv University, Israel; the Medical Statistics Branch, Israel Defence Forces Corps

To estimate the effect of neonatal hyperbilirubinemia on long-term cognitive ability in full-term newborns with a negative Coombs test, we performed a 17-year historical prospective study of 1948 subjects. Intelligence tests and medical examinations performed at the military draft board were stratified according to serum bilirubin concentration. A logistic regression analysis was used to adjust for the confounding effects of gestational age, birth weight, Apgar score, ethnic origin, socioeconomic class, paternal education, birth order, and the administration of phototherapy and exchange transfusion. No direct linear association was shown between neonatal bilirubin levels and intelligence test scores or school achievement at 17 years of age. However, the risk for low intelligence test scores (IQ score <85) was found to be significantly higher (P = .014) among full-term male subjects with serum bilirubin levels above 342 µmol/L (20 mg/dL) (odds ratio, 2.96; 95% confidence interval, 1.29-6.79). This association was not observed among female subjects. We conclude that severe neonatal hyperbilirubinemia, among full-term male newborns with a negative Coombs test, could be associated with lower IQ scores at 17 years of age.

Key Words: neonatal hyperbilirubinemia • jaundice • long-term outcome • cognitive performance • intelligence test scores

Submitted on October 15, 1990
Accepted on January 28, 1991




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