Clin Exp Otorhinolaryngol.  2019 May;12(2):163-168. 10.21053/ceo.2018.00899.

Hyperbilirubinemia and Follow-up Auditory Brainstem Responses in Preterm Infants

• Nam GS
• Kwak SH
• Bae SH
• Kim SH
• Jung J
• Choi JY

• KMID: 2447424
• DOI: http://doi.org/10.21053/ceo.2018.00899

Abstract

OBJECTIVES
.: Neonatal hyperbilirubinemia is considered one of the most common causative factors of hearing loss. Preterm infants are more vulnerable to neuronal damage caused by hyperbilirubinemia. This study aimed to evaluate the effect of hyperbilirubinemia on hearing threshold and auditory pathway in preterm infants by serial auditory brainstem response (ABR). In addition, we evaluate the usefulness of the unconjugated bilirubin (UCB) level compared with total serum bilirubin (TSB) on bilirubin-induced hearing loss.
METHODS
.: This study was conducted on 70 preterm infants with hyperbilirubinemia who failed universal newborn hearing screening by automated ABR. The diagnostic ABR was performed within 3 months after birth. Follow-up ABR was conducted in patients with abnormal results (30 cases). TSB and UCB concentration were compared according to hearing threshold by ABR.
RESULTS
.: The initial and maximal measured UCB concentration for the preterm infants of diagnostic ABR ≥40 dB nHL group (n=30) were statistically higher compared with ABR ≤35 dB nHL group (n=40) (P=0.031 and P=0.003, respectively). In follow-up ABR examination, 13 of the ABR ≥40 dB nHL group showed complete recovery, but 17 had no change or worsened. There was no difference in bilirubin level between the recovery group and non-recovery group.
CONCLUSION
.: UCB is a better predictor of bilirubin-induced hearing loss than TSB in preterm infants as evaluated by serial ABR. Serial ABR testing can be a useful, noninvasive methods to evaluate early reversible bilirubin-induced hearing loss in preterm infants.

Keyword

Hyperbilirubinemia; Bilirubin; Auditory Brain Stem Evoked Responses; Premature Infant

MeSH Terms

Auditory Pathways
Bilirubin
Evoked Potentials, Auditory, Brain Stem*
Follow-Up Studies*
Hearing
Hearing Loss
Humans
Hyperbilirubinemia*
Hyperbilirubinemia, Neonatal
Infant, Newborn
Infant, Premature*
Mass Screening
Neurons
Parturition
Bilirubin

Figure

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  Fig. 1. Flow diagram with included and hearing characteristics of preterm infants in neonatal intensive care unit (NICU). AABR, automated ABR; ABR, auditory brainstem response.

• 

  Fig. 2. Correlation between bilirubin concentration and diagnostic auditory brainstem response (ABR) threshold. (A) Relationship between unconjugated bilirubin (UCB) and ABR threshold. (B) Relationship between total serum bilirubin (TSB) and ABR threshold.

• 

  Fig. 3. Receiver operating characteristic curves predicting the risk of hearing loss according to bilirubin level. UCB, unconjugated bilirubin; TSB, total serum bilirubin; AUC, area under the curve; SE, standard error; sig, significance; CI, confidence interval. a)Under the nonparametric assumption. b)Null hypothesis: true area, 0.5.

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