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The risk of newborns with jaundice getting a rare form of cerebral palsy is virtually nil if guidelines developed by the American Academy of Pediatrics (AAP) are followed.

Yet the authors of a study in JAMA Pediatrics say the guidelines would benefit from some revision.

High levels of the yellowish pigment bilirubin cause jaundice, but the condition usually disappears without treatment.

If it doesn’t, the first-line treatment is phototherapy. If that fails, there’s exchange infusion, which involves replacing the infant’s blood with donor blood, a procedure that comes with risks of blood clots, bleeding, and blood pressure instability.

Researchers at UCSF Benioff Children’s Hospital in San Francisco were especially interested in kernicterus, a neurological disorder triggered by high levels of bilirubin that can cause a rare and life-threatening type of cerebral palsy.

The study involved two groups selected from over 520,000 babies born in 15 hospitals in the Kaiser Permanente Northern California region from 1995 through 2011.

One group included about 1,800 infants with levels of bilirubin above the AAP guidelines. The other included about 100,000 newborns with lower levels. The two groups were followed for seven and six years respectively.

Three newborns with the highest levels of bilirubin had kernicterus, but they also had other risk factors, including hemolysis or sepsis.

Cerebral palsy caused by kernicterus did not occur in any newborn with high levels of bilirubin without other risk factors being present.

Yvonne W. Wu, MD, MPH, the study leader, said that the current guidelines for when to perform exchange transfusions has prevented kernicterus, but the study results suggest that the threshold for the blood exchange procedure could be higher for infants with high bilirubin levels who are otherwise healthy and who have no other risk factors for brain injury.

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