Significant neonatal jaundice (NJ) in newborns is quite different from physiological jaundice because of earlier and/or more rapid increase in bilirubin level. These cases warrant the need of admission as their bilirubin level meet with the criteria for intervention followed by investigations. SJN is known to pose a significant challenge because of bilirubin-associated neurotoxicity which is caused by the spread of unconjugated bilirubin across the immature blood-brain barrier. This neurotoxicity can lead to kernicterus, neurological dysfunctions and death, which indicates that more emphasis should be given to treating infants exposed to mild degrees of neonatal hyperbilirubinemia. 

The investigators of the present study aimed to determine the risk of long-term neurodevelopmental sequelae of SNJ in 66,983 neonates born from 2000-2003. These neonates were evaluated for the accumulative incidence of long-term (7-year) neurodevelopmental sequelae in contrast to a reference general-population neonate cohort of 12,579 individuals born in 2000. 

The SNJ follow-up cohort was then classified into subgroups according to interventions, such as phototherapy (71.8%), intensive phototherapy (15.2%), and exchange transfusion (0.38%). 

The results showed remarkably higher cumulative rates of long-term neurodevelopmental sequelae by SNJ follow-up cohort, in comparison to reference cohort. The risks of infantile cerebral palsy, hearing loss, and developmental delay in the SNJ follow-up cohort were between twice and three times of those in the reference cohort, while adjusting for gender, comorbid perinatal disorders and urbanization levels. All intervention subgroups showed increased risks for long-term neurodevelopmental sequelae in comparison to the reference cohort. 

To conclude, patients with SNJ usually develop neurodevelopmental disorders during their growth period. Hence, SNJ should not be underestimated and follow-up protocol of physical and neurodevelopmental assessment should be conducted during early childhood. Early identification of these patients will be eventually beneficial for the early detection and intervention for neurodevelopmental disorders.

Source: Tsao PC, Yeh HL, Shiau YS, et al. Long-term neurodevelopmental outcomes of significant neonatal jaundice in Taiwan from 2000-2003: a nationwide, population-based cohort study. Sci Rep. 2020;10(1):11374. Published 2020 Jul 9.