ABSTRACT
We unknowingly “screened” all NICU infants for elevated levels of serum benzyl alcohol
(Bz-OH) over a three-month period. The fortuitous “screening” procedure resulted from
the interference by Bz-OH with a routine blood CO2 assay used for all infants; validity
was proved by (1) replication of the interference pattern with Bz-OH or benzoic acid;
(2) confirmation of elevated benzoic acid levels in serum in two of the four screening
positive infants tested but not in control infants, and (3) disappearance of the interference
patterns when Bz-OH solutions were discontinued in affected infants. Screened Bz-OH-positive
infants were compared to screened negative control infants, matched for weight (<1000
g), severity of RDS (on respirators), exposure to Bz-OH, and survival for longer than
48 hours. Intraventricular hemorrhage (IVH), metabolic acidosis appearing prior to
IVH, and mortality were increased in Bz-OH-positive infants (P <.05 in each case);
hyperbilirubinemia and thrombocytopenia were not. Gasping respirations were not a
major symptom. It is concluded that Bz-OH poisoning was a major cause of morbidity
and mortality in NICU infants weighing less than 1000 g at birth during the three-month
screening period. A retrospective review of patient records covering a 16-month period
showed significant improvement in the survival rate of infants weighing less than
1000 g following the discontinuation of Bz-OH solutions.
