Abstract
The objective was to determine frequency of sensorineural hearing loss (SNHL), identified by abnormal threshold in evoked potentials, absence of otoacoustic emissions and behavioral responses, auditory neuropathy (AN) (absence of evoked potentials, with preservation of otoacoustic emissions), and neurological comorbidity in infants with hyperbilirubinemia (HB) treated with exchange-transfusion (ET). From a total of 7,219 infants, ET was performed on 336 (4.6%). Inclusion criteria were fulfilled in 102; 234 children did not meet criteria (182 outside of the study period, 34 did not have complete audiological evaluation, and 18 rejected the followup). Thirty-five children (34%) were born at-term and 67 (66%) were preterm. Children had a mean age of 5.5 ± 3.9 years. Main causes of ET were Rh isoimmunization in 48 (47%), ABO incompatibility in 28 (27.5%), and multifactorial causes in 26 (25.5%). Fifteen (15%) children presented with SNHL. Preterm newborns presented more often with SNHL. Indirect bilirubin level was higher in children with SNHL (22.2 versus 18.7 mg/dL, P = 0.02). No cases of AN were documented. An increased risk of neurologic sequelae was observed in children with SNHL. In conclusion, we disclosed a high frequency of SNHL in children with neonatal HB and ET and neurological alterations. No cases of AN were observed.
Highlights
The auditory pathway is known as one of the most susceptible parts of the central nervous system to noxious agents
Surviving infants are at high risk of neurological damage, which can manifest as cerebral palsy, epilepsy, sensorineural hearing loss (SNHL), or cognitive deficits [5,6,7,8,9]
Thirty-five children (34%) were born at term and 67 (66%) were preterm; we found fifteen patients (15%) with SNHL in our sample
Summary
The auditory pathway is known as one of the most susceptible parts of the central nervous system to noxious agents. Severe neonatal hyperbilirubinemia (HB) is a common cause of sensorineural hearing loss (SNHL) and auditory neuropathy (AN) [1,2,3,4]. Some audiological studies in children with serum bilirubin levels >20 mg/dL, have reported auditory dysfunction in 17–87% of cases [10,11,12,13,14]. The usual treatments for this neonatal disease are phototherapy and blood exchange transfusion (ET). Some adverse events associated with ET are asymptomatic electrolyte and other blood abnormalities, which are treatable in the neonate. 74% of ET were associated with adverse events; the most common events were thrombocytopenia (44%), hypocalcemia (29%), and metabolic acidosis (24%), of which 69%, 74%, and 44%, respectively, required treatment [15, 16]
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