This article is adapted from a published
evidence report concerning neonatal hyperbilirubinemia
with an added section on the risk of blood exchange
transfusion (BET). Based on a summary of multiple case
reports that spanned more than 30 years, we conclude
that kernicterus, although infrequent, has at least 10%
mortality and at least 70% long-term morbidity. It is
evident that the preponderance of kernicterus cases occurred
in infants with a bilirubin level higher than 20
mg/dL. Given the diversity of conclusions on the relationship
between peak bilirubin levels and behavioral
and neurodevelopmental outcomes, it is apparent that
the use of a single total serum bilirubin level to predict
long-term outcomes is inadequate and will lead to conflicting
results. Evidence for efficacy of treatments for
neonatal hyperbilirubinemia was limited. Overall, the 4
qualifying studies showed that phototherapy had an absolute
risk-reduction rate of 10% to 17% for prevention of
serum bilirubin levels higher than 20 mg/dL in healthy
infants with jaundice. There is no evidence to suggest
that phototherapy for neonatal hyperbilirubinemia has
any long-term adverse neurodevelopmental effects.