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PEDIATRICS Vol. 110 No. 5 November 2002, pp. 1032

33 272 Infants, 7-Year Follow-up: Total Serum Bilirubin, Transfusions Reexamined

To the Editor.—

The long-term effect of elevated total serum bilirubin (TSB) levels on neurologic outcome remains controversial.¹ In 1993 we reported an analysis of data from the US Collaborative Perinatal Project, a cohort study of infants born 1959–1966 that included neurologic examinations at age 7 on 33 272 children.² We found a statistically significant association between TSB level 20 mg/dL and "abnormal or suspicious" neurologic examination (22.4% vs 15.1%; P < .001), but no significant association between peak TSB level 20 mg/dL (342 µmol/L) and "abnormal" neurologic examinations (4.5% vs 3.8%; P = .66) at age 7 years.

Brown and Johnson³ and Johnson and Bhutani⁴ have speculated that the reason we found no association between TSB 20 mg/dL and definite neurologic abnormalities is that abnormalities were prevented by exchange transfusions, done in 53% of the infants with TSB 20 mg/dL. To examine this possibility, we stratified the analysis by whether an exchange transfusion was done. We used SAS (SAS Corp, Cary, NC) to generate the table and Stata 6.0 (College Station, TX) to calculate risk ratios, exact P values, and 95% confidence intervals, and to test for homogeneity of the Mantel Haenszel relative risk.⁵ (This last test is to investigate the statistical significance of differences in the relative risk in children who did and did not receive exchange transfusions.)

Results are shown in Table 1. Although there was a trend toward a higher relative risk in children who had not had exchange transfusions, neither this relative risk itself nor the test for a difference in relative risk by exchange transfusion history approached statistical significance. Although it is possible that exchange transfusion may have prevented neurologic abnormalities in some of the patients in whom it was done, the risk of abnormalities in infants with TSB 20 mg/dL who did not receive an exchange was also low, and similar to the risk in children who had lower TSB levels. We conclude that the low risk of abnormal 7-year neurologic examinations in children whose maximum bilirubin levels were 20 mg/dL in the CPP is not primarily attributable to use of exchange transfusions.

View this table: [in this window] [in a new window]   TABLE 1. 7-Year Neurologic Examination Results by Maximum TSB Level, Stratified by Exchange Transfusion*

 

Thomas B. Newman, MD, MPH
Departments of Epidemiology and Biostatistics and Pediatrics
School of Medicine, University of California
San Francisco, CA 94143-0560 USA

Mark Klebanoff
Division of Epidemiology, Statistics and Prevention Research
National Institute of Child Health and Human Development, NIH
Bethesda, MD 20892, USA

REFERENCES

1. Poland RL. Preventing kernicterus: almost there. J Pediatr.2002; 140 :385 –386[CrossRef][Web of Science][Medline]
2. Newman TB, Klebanoff MA. Neonatal hyperbilirubinemia and long-term outcome: another look at the Collaborative Perinatal Project. Pediatrics.1993; 92 :651 –657[Abstract/Free Full Text]
3. Brown AK, Johnson L. Loss of concern about jaundice and the reemergence of kernicterus in full term infants in the era of managed care. In: Fanaroff A, Klaus M, eds. Yearbook of Neonatal and Perinatal Medicine. St Louis, MO: Mosby Yearbook; 1996:xvii–xxviii
4. Brown AK, Johnson L, Bhutani VK. Guidelines for management of the jaundiced term and near-term infant. Clin Perinatol.1998; 25 :555 –74, viii[Web of Science][Medline]
5. Statcorp. Stata statistical software: Release 6.0. College Station, TX: Stata Corporation; 1999

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PEDIATRICS (ISSN 1098-4275). ©2002 by the American Academy of Pediatrics

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This Article Extract Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Web of Science (2) Citing Articles via Google Scholar Google Scholar Articles by Newman, T. B. Articles by Klebanoff, M. Search for Related Content PubMed PubMed Citation Articles by Newman, T. B. Articles by Klebanoff, M. Related Collections Infectious Disease & Immunity Social Bookmarking                         What's this?