Search

Background Aim: Kernicterus is the most feared and the best described complication of untreated neonatal hyperbilirubinemia (NH). More common complications and their impact on neurodevelopmental outcome/ impairment (NDO/I) remain unclear. We performed a systematic review of the literature since 2001 on kernicterus, hearing and visual outcome, NDO/I and secondarily on nevi development, phototherapy induced DNA-changes and other controversial outcomes.Method: A standardized, systematic search was performed (Medline, Embase and Cochrane database). After screening titles and abtracts, full articles were assessed and eligible ones were included and graded according their level of evidence.Results: From 557 hits, 39 studies were included. The following outcomes were included (the number corresponds to the number of articles addressing each outcome): 5 kernicterus, 6 hearing impairment, 6 visual outcome, 2 retinopathy of prematurity (ROP), 18 NDO/I, 2 nevi, 4 autism and 1 each for asthma, cerebral MRI changes and attention deficit syndromes (ADS). Besides the development of kernicterus we found a clear correlation between NH and NDO/I as well as a significantly lowered IQ in the presence of a positive coombs test. No correlation between NH and visual impairment or ROP was seen, whereas hearing impairment, nevi development, phototherapy induced DNA changes or later apparent ADS and asthma remain controversial.Conclusion: NDO/I and kernicterus are the most commonly reported complications of NH. The impact of NH on more frequent and less severely disabling outcomes like hearing or visual impairment remains unclear. New controversies on the possible association between NH and asthma, ADS or autism arise.

Reaction of the benzocycloheptenylium perchlorates (I) with the diazo compounds (II) leads to the tetracycles (III), which arise from intramolecular cycloaddition of the intermediately formed 5H‐benzocycloheptenes (IV).