Long-term effects of indirect hyperbilirubinemia on auditory and neurological functions in term newborns Term yenidoğanlarda indirekt hiperbilirubineminin işitsel ve nörolojik fonksiyonlar üzerine uzun dönem etkileri


Besli G. E. , Metin F., Aksit M. A. , SALTIK S.

Medeniyet Medical Journal, cilt.35, sa.1, ss.29-39, 2020 (Diğer Kurumların Hakemli Dergileri) identifier identifier

  • Yayın Türü: Makale / Tam Makale
  • Cilt numarası: 35 Konu: 1
  • Basım Tarihi: 2020
  • Doi Numarası: 10.5222/mmj.2020.26986
  • Dergi Adı: Medeniyet Medical Journal
  • Sayfa Sayıları: ss.29-39

Özet

© Istanbul Medeniyet University Faculty of Medicine.Objective: The aim of this study was to investigate the long-term effects of hyperbilirubinemia on neurological and hearing function in otherwise healthy term newborns with neonatal indirect hyperbilirubine-mia. Method: This study was performed prospectively in 41 term newborns hospitalized for indirect hyperbili-rubinemia. Patients with no signs of hemolysis were categorized in 3 groups based on stabil levels as sTB <20 mg/dl, 20-24.9 mg/dl, and =>25 mg/dl. Patients with total bilirubin level =>20 mg/dl and hemolytic disease were classified as the fourth group. The relationship between maximum sTB level, duration of exposure to sTB levels >20 mg/dl and etiology of jaundice with neurological and auditory functions was investigated. Detailed neurological examination, Denver II developmental screening test and hearing tests (otoacoustic emissions, OAE and auditory brainstem responses, ABR) were performed to all patients between 18-24 months of age. Results: Neurodevelopmental disorder was found in 5 (12.2%) patients. Hemolytic disease was detected in two of these patients. Hearing loss was found in 4 (9.8%) of the patients. Two of these patients had auditory neuropathy spectrum disorder and the other two had cochlear hearing loss. The sTB levels of all these patients were above 25 mg/dl. No neurological disorder or hearing loss was found in the patients who had stabil of <25 mg/dl. Exposure time to sTB levels above 20 mg/dl was significantly longer in patients with neurological dysfunction and pathologic ABR results (p:0.007, p:0.007; p<0.05). Conclusion: This study demonstrates that kernicterus may develop in term newborns with severe hy-perbilirubinemia (sTB>25 mg/dl) without any finding of significant hemolysis. Not only the bilirubin level but also the duration of exposure to high bilirubin levels may be effective in the development of bilirubin neurotoxicity. The high rate of hearing loss in our patients emphasizes the importance of screening for infants with severe hyperbilirubinemia using comprehensive auditory evaluation for early diagnosis of possible hearing loss.