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Pediatr Res. 2013 May;73(5):655-60. doi: 10.1038/pr.2013.28. Epub 2013 Feb 13.

Neurodevelopment after moderate hyperbilirubinemia at term.

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  • 1Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.



The aim of this work was to investigate in a prospective study whether moderate hyperbilirubinemia in healthy term neonates is associated with an increase of minor neurological dysfunction (MND) and behavioral problems up to 18 mo.


We enrolled 43 healthy term infants with a bilirubin level ≥ 220 µmol/l (BILI group) at 72-96 h postnatally at the University Medical Center Groningen (UMCG), including eight referrals for hyperbilirubinemia. Seventy healthy term infants born at the UMCG with bilirubin level <220 µmol/l served as comparisons (COMP group). We evaluated the neurologic condition neonatally and at 3 and 18 mo; behavior was evaluated at birth and 18 mo.


Rates of MND in BILI and COMP groups were similar at all ages. However, bilirubin levels of ≥ 300 µmol/l (n = 10) were associated with an increased risk of complex MND (odds ratio: 4.21; 95% confidence interval: 1.02-17.37). Neonatally, BILI infants were more often lethargic than COMP infants (odds ratio: 3.54; 95% confidence interval: 1.32-9.51); at 18 mo, they had higher hyperactivity scores (effect: 0.32; 95% confidence interval: 0.08-0.56).


Occurrence of complex MND at 18 mo in infants with moderate hyperbilirubinemia was not different from that in comparison infants, but bilirubin level ≥ 300 was associated with an increased risk of complex MND. This study also suggests that minor behavioral effects of moderate hyperbilirubinemia cannot be excluded.

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