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Zidan LK, Rowisha MA, Nassar MAE, Elshafey RA, El Mahallawi TH, Elmahdy HS. Magnetic resonance spectroscopy and auditory brain-stem response audiometry as predictors of bilirubin-induced neurologic dysfunction in full-term jaundiced neonates. Eur J Pediatr 2024; 183:727-738. [PMID: 37979048 PMCID: PMC10912194 DOI: 10.1007/s00431-023-05246-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/22/2023] [Accepted: 09/28/2023] [Indexed: 11/19/2023]
Abstract
The purpose of this research was to define the functions of MRS and ABR as predictors of bilirubin-induced neurologic dysfunction (BIND) in full-term neonates who required intervention (phototherapy and/or exchange transfusion). This prospective cohort study was done at the NICU of Tanta University Hospitals over a 2-year duration. Fifty-six full-term neonates with pathological unconjugated hyperbilirubinemia were divided according to MRS and ABR findings into 2 groups: group (1) included 26 cases with mild acute bilirubin encephalopathy (BIND-M score 1-4). Group (2) included 30 cases with neonatal hyperbilirubinemia only. In addition, 20 healthy neonates with similar ages were employed as the controls. When compared to group 2 and the control group, group 1's peak-area ratios of NAA/Cr and NAA/Cho were found to be significantly reduced (P < 0.05). As compared to group 2 and the control group, group 1's Lac/Cr ratio was significantly greater (P < 0.05), but the differences were not significant for group 2 when compared to the control group. Waves III and V peak latencies, I-III, and I-V interpeak intervals were significantly prolonged in group 1 in comparison to group 2 and controls (P < 0.05) with no significant difference between group 2 and control group. Conclusion: When the symptoms of ABE are mild and MRI does not show any evident abnormalities, MRS and ABR are helpful in differentiating individuals with ABE from patients with neonatal hyperbilirubinemia. Trial registration: ClinicalTrials.gov , Identifier: NCT06018012. What is Known: • MRS can be used as a diagnostic and prognostic tool for the differential diagnosis of patients with acute bilirubin encephalopathy, from patients with neonatal hyperbilirubinemia What is New: • ABR is a useful diagnostic and prognostic tool in the care and management of neonates with significantly raised bilirubin. It can be used as early predictor of acute bilirubin encephalopathy in the earliest stage of auditory damage caused by bilirubin.
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Affiliation(s)
| | | | | | | | | | - Heba Saied Elmahdy
- Pediatric Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
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Özer F. Effect of Hyperbilirubinemia on Medial Olivocochlear System in Newborns. J Int Adv Otol 2020; 16:295-296. [PMID: 32784171 DOI: 10.5152/iao.2020.8592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Fulya Özer
- Department of Oto-Rhino-Laryngology and Head Neck Surgery, Başkent University School of Medicine, Ankara, Turkey
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Karabulut B, Sürmeli M, Bozdağ Ş, Deveci İ, Doğan R, Oysu Ç. Effect of Hyperbilirubinemia on Medial Olivocochlear System in Newborns. J Int Adv Otol 2020; 15:272-276. [PMID: 31120424 DOI: 10.5152/iao.2019.5723] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To evaluate medial olivocochlear efferent system of babies with hyperbilirubinemia with normal auditory brain stem responses. MATERIALS AND METHODS This was a prospective study in a tertiary referral hospital. The study involved 40 hyperbilirubinemic and 44 healthy newborns. Cochlear and auditory activity of participants was evaluated by transient otoacoustic emissions (TOAEs) and brainstem auditory evoked response components (BAER). Medial olivocochlear (MOC) reflex was evoked with contralateral acoustic stimulation and recorded with TOAEs. RESULTS A comparison of the MOC reflex activity between two groups with Mann Whitney U test revealed that MOC reflex activity were significantly decreased in the hyberbilirubinemic group for both ears (p<.05). This difference was significant for all frequencies in both ears. There was no significant relation between total serum bilirubin level and MOC reflex activity. CONCLUSION Hyperbilirubinemic newborns had decreased MOC reflex activity. This may be indicative of future problems in speech discrimination and effective hearing in noisy background. Additional long cohort studies are needed to evaluate the clinical importance of MOC reflex measurements in this group. MOC reflex measurement has the potential to form part of the audiologic evaluation of newborns with hyperbilirubinemia in the future.
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Affiliation(s)
- Burak Karabulut
- Department of Otolaryngology, Ümraniye Training and Research Hospital, İstanbul, Turkey
| | - Mehmet Sürmeli
- Department of Otolaryngology, Ümraniye Training and Research Hospital, İstanbul, Turkey
| | - Şenol Bozdağ
- Neonatal Intensive Care Unit, Ümraniye Training and Research Hospital, İstanbul, Turkey
| | - İldem Deveci
- Department of Otolaryngology, Ümraniye Training and Research Hospital, İstanbul, Turkey
| | - Rıza Doğan
- Audiology Unit, Ümraniye Training and Research Hospital, İstanbul, Turkey
| | - Çağatay Oysu
- Department of Otolaryngology, Ümraniye Training and Research Hospital, İstanbul, Turkey
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Pittet-Metrailler MP, Almazrooei AM, Tam EW. Sensory assessment: Neurophysiology in neonates and neurodevelopmental outcome. HANDBOOK OF CLINICAL NEUROLOGY 2020; 174:183-203. [DOI: 10.1016/b978-0-444-64148-9.00014-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Ye H, Xing Y, Zhang L, Zhang J, Jiang H, Ding D, Shi H, Yin S. Bilirubin-induced neurotoxic and ototoxic effects in rat cochlear and vestibular organotypic cultures. Neurotoxicology 2018; 71:75-86. [PMID: 30578813 DOI: 10.1016/j.neuro.2018.12.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 12/16/2018] [Accepted: 12/18/2018] [Indexed: 12/15/2022]
Abstract
Exposure to high levels of bilirubin in hyperbilirubinemia patients and animal models can result in sensorineural deafness. However, the mechanisms underlying bilirubin-induced damage to the inner ear, including the cochlear and vestibular organs, remain unknown. The present analyses of cochlear and vestibular organotypic cultures obtained from postnatal day 3 rats exposed to bilirubin at varying concentrations (0, 10, 50, 100, or 250 μM) for 24 h revealed that auditory nerve fibers (ANFs) and vestibular nerve endings were destroyed even at low doses (10 and 50 μM). Additionally, as the bilirubin dose increased, spiral ganglion neurons (SGNs) and vestibular ganglion neurons (VGNs) exhibited gradual shrinkage in conjunction with nuclei condensation or fragmentation in a dose-dependent manner. The loss of cochlear and vestibular hair cells (HCs) was only evident in explants treated with the highest concentration of bilirubin (250 μM), and bilirubin-induced major apoptosis most likely occurred via the extrinsic apoptotic pathway. Thus, the present results indicate that inner ear neurons and fibers were more sensitive to, and exhibited more severe damage following, bilirubin-induced neurotoxicity than sensory HCs, which illustrates the underlying causes of auditory neuropathy and vestibulopathy in hyperbilirubinemia patients.
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Affiliation(s)
- Haibo Ye
- Department of Otorhinolaryngology, Affiliated Sixth People's Hospital of Shanghai Jiaotong University, 600 Yishan Road, Shanghai 200233, PR China
| | - Yazhi Xing
- Department of Otorhinolaryngology, Affiliated Sixth People's Hospital of Shanghai Jiaotong University, 600 Yishan Road, Shanghai 200233, PR China
| | - Ling Zhang
- Department of Otorhinolaryngology, Affiliated Sixth People's Hospital of Shanghai Jiaotong University, 600 Yishan Road, Shanghai 200233, PR China
| | - Jianhui Zhang
- Department of Otolaryngology Head and Neck Surgery, The Third People's Hospital of Chengdu, PR China
| | - Haiyan Jiang
- Center for Hearing and Deafness, Department of Communicative Disorders and Sciences State, University of New York at Buffalo, 137 Cary Hall, 3435 Main Street, Buffalo, NY 14214, USA
| | - Dalian Ding
- Department of Otorhinolaryngology, Affiliated Sixth People's Hospital of Shanghai Jiaotong University, 600 Yishan Road, Shanghai 200233, PR China; Center for Hearing and Deafness, Department of Communicative Disorders and Sciences State, University of New York at Buffalo, 137 Cary Hall, 3435 Main Street, Buffalo, NY 14214, USA.
| | - Haibo Shi
- Department of Otorhinolaryngology, Affiliated Sixth People's Hospital of Shanghai Jiaotong University, 600 Yishan Road, Shanghai 200233, PR China.
| | - Shankai Yin
- Department of Otorhinolaryngology, Affiliated Sixth People's Hospital of Shanghai Jiaotong University, 600 Yishan Road, Shanghai 200233, PR China
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Okhravi T, Tarvij Eslami S, Hushyar Ahmadi A, Nassirian H, Najibpour R. Evaluation of auditory brain stems evoked response in newborns with pathologic hyperbilirubinemia in mashhad, iran. IRANIAN RED CRESCENT MEDICAL JOURNAL 2015; 17:e18288. [PMID: 25793115 PMCID: PMC4353218 DOI: 10.5812/ircmj.18288] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 04/07/2014] [Accepted: 05/03/2014] [Indexed: 11/21/2022]
Abstract
Background: Neonatal jaundice is a common cause of sensorneural hearing loss in children. Objectives: We aimed to detect the neurotoxic effects of pathologic hyperbilirubinemia on brain stem and auditory tract by auditory brain stem evoked response (ABR) which could predict early effects of hyperbilirubinemia. Patients and Methods: This case-control study was performed on newborns with pathologic hyperbilirubinemia. The inclusion criteria were healthy term and near term (35 - 37 weeks) newborns with pathologic hyperbilirubinemia with serum bilirubin values of ≥ 7 mg/dL, ≥ 10 mg/dL and ≥14 mg/dL at the first, second and third-day of life, respectively, and with bilirubin concentration ≥ 18 mg/dL at over 72 hours of life. The exclusion criteria included family history and diseases causing sensorineural hearing loss, use of auto-toxic medications within the preceding five days, convulsion, congenital craniofacial anomalies, birth trauma, preterm newborns < 35 weeks old, birth weight < 1500 g, asphyxia, and mechanical ventilations for five days or more. A total of 48 newborns with hyperbilirubinemia met the enrolment criteria as the case group and 49 healthy newborns as the control group, who were hospitalized in a university educational hospital (22 Bahaman), in a north-eastern city of Iran, Mashhad. ABR was performed on both groups. The evaluated variable factors were latency time, inter peak intervals time, and loss of waves. Results: The mean latencies of waves I, III and V of ABR were significantly higher in the pathologic hyperbilirubinemia group compared with the controls (P < 0.001). In addition, the mean interpeak intervals (IPI) of waves I-III, I-V and III-V of ABR were significantly higher in the pathologic hyperbilirubinemia group compared with the controls (P < 0.001). For example, the mean latencies time of wave I was significantly higher in right ear of the case group than in controls (2.16 ± 0.26 vs. 1.77 ± 0.15 milliseconds, respectively) (P < 0.001). Conclusions: Pathologic hyperbilirubinemia causes acute disorder on brain stem function; therefore, early diagnosis of neonatal jaundice for prevention of bilirubin neurotoxic effects is essential. As national neonatal hearing screening in not yet established in Iran, we recommend performing ABR for screening of bilirubin neurotoxicity in all cases with hyperbilirubinemia.
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Affiliation(s)
- Tooba Okhravi
- Student Research Committee, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, IR Iran
- ABR Center, Mashhad Branch, Islamic Azad University, Mashhad, IR Iran
| | - Saeedeh Tarvij Eslami
- Department of Pediatrics, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, IR Iran
- Corresponding Author: Saeedeh Tarvij Eslami, Department of Pediatrics, Islamic Azad University, Tehran Medical Sciences Branch, Tehran, IR Iran. Tel: +98-9128444226, Fax: +98-2189787379, E-mail:
| | | | - Hossain Nassirian
- Department of Pediatrics, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, IR Iran
| | - Reza Najibpour
- Student Research Committee, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, IR Iran
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Abstract
CONCLUSION This study suggests that hyperbilirubinemia in the neonatal rat can impair auditory function and induce peripheral nerve pathology by reducing neurofilament-positive cells in spiral ganglion neurons (SGNs). This finding indicates a potential connection between hyperbilirubinemia and auditory impairment. OBJECTIVE To establish a neonatal rat hyperbilirubinemia induced by hemolysis and assess the possible link between hyperbilirubinemia and auditory impairment. METHODS Wistar rats were divided into two groups - a bilirubin exposure group injected with phenylhydrazine hydrochloride at 7 and 28 days of age to induce hyperbilirubinemia, and a control group given saline. Auditory brainstem response (ABR) and distortion product otoacoustic emissions (DPOAEs) were determined to assess auditory function. Cochlea basilar membrane stretch preparations and cochlear frozen sections were examined for morphological changes in hair cells and SGNs. RESULTS At day 7, ABR wave I, III, and V latencies, and I-III, I-V interwave intervals (IWIs) in the experimental group were significantly prolonged compared with those in the control group. ABR thresholds were also elevated in the experimental group. We found no significant difference in DPOAEs in the bilirubin exposure group compared to the control group. The ABRs and DPOAEs in the experimental group were restored at age 28 days. Cochlear hair cells showed no signs of loss in either group; however, the total number of neurofilament-positive cells in SGNs was significantly reduced in the phenylhydrazine-treated animals.
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Affiliation(s)
- Qi Li
- Department of Otolaryngology, Nanjing Children's Hospital, Nanjing Medical University , Nanjing , Jiangsu
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Weiwei G, Peipei C, Xiaoquan W, Shiming Y. A Method for Establishing an Animal Model of Like-Auditary Neuropathy. J Otol 2014. [DOI: 10.1016/s1672-2930(14)50009-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Impaired function of the auditory brainstem in term neonates with hyperbilirubinemia. Brain Dev 2014; 36:212-8. [PMID: 23587715 DOI: 10.1016/j.braindev.2013.03.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 03/09/2013] [Accepted: 03/13/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We studied maximum length sequence brainstem auditory evoked response in term neonates with hyperbilirubinemia to further our understanding of hyperbilirubinemia on the neonatal auditory brainstem and to determine if maximum length sequence technique improves detection of brainstem auditory impairment due to bilirubin neurotoxicity. METHODS Maximum length sequence brainstem auditory evoked response was recorded and analysed shortly after confirming total serum bilirubin levels greater than 15mg/dL in fifty-seven term neonates with hyperbilirubinemia. RESULTS Most wave latencies and interpeak intervals in maximum length sequence brainstem auditory evoked response in the neonates with hyperbilirubinemia were correlated with the level of total serum bilirubin at some or most click rates used. Compared with age-matched normal term controls, wave V latency in these neonates was increased significantly at all 91-910/s click rates (p<0.05-0.001). The I-V and I-III interpeak intervals were also increased significantly at all these rates, and the III-V interval increased at 227-910/s clicks (p<0.05-0.001). The differences between the neonates with hyperbilirubinemia and the controls were more significant at higher than at lower click rates. The slopes of wave V latency-rate function and I-V and III-V interval-rate functions were all significantly increased. By comparison, the abnormalities in conventional BAER were less significant, with only I-III and I-V intervals were increased (both p<0.05). CONCLUSIONS Functional status of the auditory brainstem is impaired in neonatal hyperbilirubinemia. Maximum length sequence technique at high click rates improves detection of bilirubin neurotoxicity to the neonatal auditory brainstem, particularly for the more rostral regions.
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Vinodh M, Ambikapathy P, Aravind MA, Ganesh J. Reversibility of brainstem evoked response audiometry abnormalities at 3 months in term newborns with hyperbilirubinemia. Indian Pediatr 2013; 51:134-5. [PMID: 24277970 DOI: 10.1007/s13312-014-0346-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Accepted: 09/05/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND High bilirubin level is toxic to developing brain and auditory system but the current debate surrounds the toxicity of bilirubin in healthy term infants. METHODS Longitudinal observational study to find BERA abnormalities in term newborns with isolated hyperbilirubinemia of 20 mg/dL and more and to follow up babies at 3 months to find out about the reversibility in BERA abnormalities noted at birth. RESULTS BERA abnormalities were present in 17.64% of babies with isolated hyperbilirubinemia at discharge. There was a reversibility of BERA abnormalities in 61.61% during follow up. CONCLUSIONS BERA abnormalities are reversible in term neonates with hyperbilirubinemia.
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Affiliation(s)
- M Vinodh
- Department of Paediatrics, Government Stanley Medical College, Chennai, TN, India. Correspondence to: Dr M Vinodh, Department of Paediatrics, Govt Stanley Medical College, Chennai 600 001, TN, India.
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Panahi R, Jafari Z, Hasani S. Relationship between behavioral hearing thresholds and estimated auditory steady-state response thresholds in children with a history of neonatal hyperbilirubinemia. Eur Arch Otorhinolaryngol 2013; 271:2385-92. [PMID: 24096813 DOI: 10.1007/s00405-013-2731-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 09/23/2013] [Indexed: 10/26/2022]
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Ye HB, Shi HB, Wang J, Ding DL, Yu DZ, Chen ZN, Li CY, Zhang WT, Yin SK. Bilirubin induces auditory neuropathy in neonatal guinea pigs via auditory nerve fiber damage. J Neurosci Res 2012; 90:2201-13. [PMID: 22847875 DOI: 10.1002/jnr.23107] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2012] [Revised: 05/28/2012] [Accepted: 05/31/2012] [Indexed: 11/07/2022]
Abstract
Bilirubin can cause temporary or permanent sensorineural deafness in newborn babies with hyperbilirubinemia. However, the underlying targets and physiological effects of bilirubin-induced damage in the peripheral auditory system are unclear. Using cochlear functional assays and electron microscopy imaging of the inner ear in neonatal guinea pigs, we show here that bilirubin exposure resulted in threshold elevation in both compound action potential (CAP) and auditory brainstem response (ABR), which was apparent at 1 hr and peaked 8 hr after drug administration. The threshold elevation was associated with delayed wave latencies and elongated interwave intervals in ABR and CAP. At 72 hr postinjection, these measures returned to control levels, except for the CAP amplitude. Cochlear microphonics remained unchanged during the experiment. Morphological abnormalities were consistent with the electrophysiological dysfunction, revealing fewer auditory nerve fibers (ANFs) in the basal turn, myelin sheath lesions of spiral ganglion neurons (SGNs) and ANFs, and loss of type 1 afferent endings beneath inner hair cells (IHCs) without loss of hair cells at 8 hr posttreatment. Similar to the electrophysiological findings, morphological changes were mostly reversed 10 days after treatment, except for the ANF reduction in the basal turn. These results suggest that hyperbilirubinemia in neonatal guinea pigs impaired auditory peripheral neuromechanisms that targeted mainly the IHC synapses and the myelin sheath of SGNs and their fibers. Our observations indicate a potential connection between hyperbilirubinemia and auditory neuropathy.
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Affiliation(s)
- Hai-Bo Ye
- Department of Otorhinolaryngology, Affiliated Sixth People's Hospital of Shanghai Jiaotong University, Shanghai, China
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James AL. The assessment of olivocochlear function in neonates with real-time distortion product otoacoustic emissions. Laryngoscope 2010; 121:202-13. [DOI: 10.1002/lary.21078] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Changes in BAER wave amplitudes in relation to total serum bilirubin level in term neonates. Eur J Pediatr 2009; 168:1243-50. [PMID: 19130081 DOI: 10.1007/s00431-008-0919-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2008] [Accepted: 12/17/2008] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Whether the severity of bilirubin neurotoxicity is closely related to the level of total serum bilirubin (TSB) remains to be determined. MATERIALS AND METHODS We studied the amplitudes of brainstem auditory evoked response (BAER) components in 83 term neonates with TSB >10 mg/dL to detect any differences in bilirubin ototoxic effect on the amplitudes between different levels of TSB. RESULTS AND DISCUSSION Compared to age-matched normal controls, the amplitudes of BAER waves III and V were reduced significantly (P<0.01 and 0.001). The V/I and V/III amplitude ratios were also decreased significantly (P<0.001 and 0.01). Although all amplitudes tended to be lower at higher TSB levels than at lower levels, none of the amplitudes correlated significantly with the level of TSB. Neither the V/I amplitude ratio nor the V/III amplitude ratio correlated with the TSB. No significant differences were found in any BAER wave amplitudes among the TSB levels 11-15, 16-20 and >20 mg/dL. In the comparison of amplitude data between any two of the three TSB levels, only wave V amplitude showed significant difference between TSB levels 11-15 and >20 mg/dL (P < 0.05). CONCLUSION BAER wave amplitudes were significantly reduced in neonates with hyperbilirubinemia. However, there was no close correlation between the degree of amplitude reduction and the level of TSB. These results indicate that bilirubin toxicity to the neonatal brain is not closely related to the level of TSB.
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