Spectrum of outcome in infants with extreme neonatal jaundice

The increasing number of case reports on neurologic sequelae related to hyp erbilirubinaemia may represent a re-emergence of kernicterus in the industr ialized world. However, not much has been written about infants who survive d extreme levels of serum bilirubin without neurologic damage. We present t hree cases of extreme neonatal hyperbilirubinaemia, all with peak serum bil irubin levels > 600 mu mol/L. Two of the infants developed neurologic seque lae, but the third infant did not. In contrast to the two with sequelae. th e infant without sequelae was female, had a positive Coombs' test, less cli nical signs compatible with bilirubin encephalopathy, and a shorter exposur e to serum bilirubin values > 400 mu moL/L. Conclusion: The basic mechanism of bilirubin neurotoxicity remains unknown, and it is not clear why some infants do not develop neurologic injury at s erum bilirubin levels at which others do. We speculate that a comparison be tween patients with sequelae and those without may yield important informat ion.