Relationship of benzyl alcohol to kernicterus, intraventricular hemorrhage, and mortality in preterm infants

Abstract

Intraventricular hemorrhage and death in preterm neonates has been associated with the use of fluid containing benzyl alcohol, a bacteriostatic agent, to flush intravascular catheters. The hospital and autopsy records of infants admitted to a nursery during the last 18 months that benzyl alcohol was in use (218 patients) were reviewed and compared with those of infants admitted in the first 18 months after benzyl alcohol was withdrawn (232 patients). The volume of flush solution administered to each patient was estimated. Exposure to benzyl alcohol was significantly associated with the development of kernicterus (P less than .005), and intraventricular hemorrhage (P less than .000,000,5). Kernicterus did not develop in any patient after benzyl alcohol was withdrawn. Many patients with kernicterus or intraventricular hemorrhages received small daily volumes of fluid containing benzyl alcohol. Withdrawal of benzyl alcohol from clinical use had no demonstrable effect on mortality. Medications intended for neonatal use should not contain benzyl alcohol. Our data indicate that patients not exposed to benzyl alcohol have a greatly reduced risk of kernicterus. If this finding is confirmed by other investigators, present indications for exchange transfusions in preterm infants with moderate elevations of serum bilirubin should be reconsidered.