Reevaluation of recent criteria for blood exchange transfusion in term infants with hyperbilirubinemia.

For hyperbilirubinemic infants treated according to the higher criterion for a blood exchange transfusion (BET), auditory brainstem response (ABR) was performed to evaluate whether the treatment was adequate. Twenty hyperbilirubinemic infants were collected as the study group. They were divided into 2 groups; group A consisted of 17 infants receiving intensive phototherapy only, while group B consisted of 3 infants receiving BET plus phototherapy. Fourteen healthy neonates were collected as the control group. Language development was evaluated with "language/communication development milestone: infancy through school-age" at the age of 5 months to 3 years old. Wave V at 30 dB HL was clearly identified in all infants in group A and in the control group. There was no significant difference in the latency between them (p > 0.05). In group A, peak bilirubin levels of 16 cases reached the former criteria for BET Their ABRs were normal. Language development was normal in 12 cases, while 4 cases were lost to follow-up. In group B, 2 cases had abnormal ABRs, while the third had normal ABR and language development. By analyzing the condition of these babies, we could conclude that in addition to peak bilirubin level and age, other factors such as anemia, the duration of hyperbilirubinemia, and the decline rate of bilirubin in response to intensive phototherapy should also be taken into consideration. For infants with borderline bilirubin levels for BET, we suggest performing BET if they have severe anemia or if intensive phototherapy fails to produce a proper decline in bilirubin.