Neonatal Hyperbilirubinemia and Chronic Auditory Toxicity

Abstract

Research Article| January 01 2018 Neonatal Hyperbilirubinemia and Chronic Auditory Toxicity AAP Grand Rounds (2018) 39 (1): 4. https://doi.org/10.1542/gr.39-1-4 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Neonatal Hyperbilirubinemia and Chronic Auditory Toxicity. AAP Grand Rounds January 2018; 39 (1): 4. https://doi.org/10.1542/gr.39-1-4 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: neonatal jaundice, toxic effect, hyperbilirubinemia Source: Amin SB, Saluja S, Saili A, et al. Chronic auditory toxicity in late preterm and term infants with significant hyperbilirubinemia. Pediatrics. 2017; 140(4): e20164009; doi: https://doi.org/10.1542/peds.2016-4009Google Scholar Investigators from multiple institutions in the United States and India conducted a prospective study to assess the association of chronic auditory toxicity and total serum bilirubin (TSB), unbound bilirubin (UB), and bilirubin albumin molar ratio (BAMR) in infants with significant neonatal hyperbilirubinemia. Study participants were infants born at ≥34 weeks’ gestation who were admitted to one of two NICUs in India with TSB levels ≥20 mg/dL or with TSB levels above the recommended threshold for exchange transfusion. In addition to TSB, both albumin levels (used to compute BAMR) and UB were measured. When study participants were 2–3 months old, they had auditory brainstem response and otoacoustic emission testing performed, along with tympanometry to detect auditory neuropathy spectrum disorder (ANSD). When the infants were 9–12 months old, they had formal auditory testing to detect sensorineural hearing loss (SNHL). Infants with either ANSD or SNHL with normal tympanometry were classified as having chronic auditory toxicity (CAT). After correcting for risk factors for bilirubin neurotoxicity (eg, perinatal asphyxia, sepsis, hypoxia, acidosis, hypoalbuminemia, and hemolysis), the association between TSB, BAMR, and UB and CAT were assessed using regression analysis. In addition, covariate-adjusted receiver operating characteristic curves were constructed using each of these markers as a predictor of CAT; the area under the curve (AUC) for each was compared. A total of 100 infants were enrolled in the study, and auditory testing was completed in 93. Overall, 12 infants (13%) were classified as having CAT, including 3 with ANSD, 4 with SNHL, and 5 with both; 4 children had profound SNHL (threshold >70 dB). Clinical characteristics were similar in infants with and without CAT. Mean peak TSB levels were 29.0 mg/dL among those with CAT and 23.6 mg/dL in infants without CAT (P = .14 after adjusting for covariates). Similarly, there was no statistically significant association between BAMR and CAT. However, UB levels were significantly higher in infants with CAT than in those without CAT (P = .001, adjusted odds ratio 2.41; 95% CI 1.43–4.07). The AUC for UB as a predictor of CAT was significantly higher than for TSB and BAMR (0.866, 0.775, and 0.724, respectively, P = .03). Among 63 study infants with a peak TSB <25 mg/dL, 5 (8%) were diagnosed with CAT. UB, but not TSB or BAMR, was significantly associated with CAT in this group of infants. The authors conclude that unconjugated bilirubin (ie, UB) is associated with CAT among infants born at ≥34 weeks’ gestation with significant hyperbilirubinemia. Dr Mintzer has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. Based on AAP guidelines, routine screening of bilirubin levels has become standard practice for the prevention of acute bilirubin encephalopathy among all newborn infants.1... You do not currently have access to this content.