Abstract
Background: Indirect hyperbilirubinemia is one of the most common causes of hospitalization in the neonatal period and its potential association with brain damage is well established. This study was conducted to determine neurodevelopmental outcome of children who had severe indirect hyperbilirubinemia in neonatal period and received intensive phototherapy with or without double volume exchange transfusion for its management. Material & methods: This descriptive analytical study was performed in healthy infants with the history of severe indirect hyperbilirubinemia and need intensive phototherapy with or without exchange transfusion. We invited the enrolled infants at their 2-3 years age. Neurodevelopmental assessment was performed by a trained nurse using Ages and Stages Questionnaire. Results: The mean total serum bilirubin (TSB) of studied children was 26.4±4.1 mg/dl at their neonatal period. The estimated rate of severe hyperbilirubinemia with the TSB of 25-30 mg/dl was 48.7/100,000 live born infants and 11.4 /100,000 for hyperbilirubinemia higher than 30 mg/dl. The most common cause of jaundice in patients with exchange transfusion was ABO incompatibility. At their follow up examination, the classic form of bilirubin induced encephalopathy (Kernicterus) was diagnosed in 3 neonates. Two of them had sensory neural hearing loss too. Eleven children had low score based on ASQ in at least one area. The score was less than 2SD in 3 patients. Conclusion: Severe hyperbilirubinemia and kernicterus is still occurring in term and late pre-term infants. Early detection and management of severe hyperbilirubinemia may improve the neurodevelopmental outcome in high risk infants.
Highlights
Indirect hyperbilirubinemia is one of the most common causes of hospitalization in the neonatal period and its potential association with brain damage is well established
Severe hyperbilirubinemia and kernicterus is still occurring in term and late preterm infants
There were 69 740 live births during study period and 181 neonates admitted with neonatal hyperbilirubinemia
Summary
Indirect hyperbilirubinemia is one of the most common causes of hospitalization in the neonatal period and its potential association with brain damage is well established. Considering that vascular compromise and oxidative stress may play important role in the development of sudden deafness and protective function of bilirubin, it is possible that inner ear injury resulted from bilateral sensory neural hearing loss can benefit from high normal or mildly elevated bilirubin level.[9] In industrialized countries the rate of bilirubin induced neurotoxicity has decreased significantly after introducing phototherapy and exchange transfusion as methods of neonatal hyperbilirubinemia management.
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