Amin Sanjiv B, Saluja Satish, Saili Arvind, Orlando Mark, Wang Hongyue, Laroia Nirupama, Agarwal Asha
Departments of Pediatrics,
Departments of Pediatrics and.
Pediatrics. 2017 Oct;140(4). doi: 10.1542/peds.2016-4009.
Significant hyperbilirubinemia (SHB) may cause chronic auditory toxicity (auditory neuropathy spectrum disorder and/or sensorineural hearing loss); however, total serum bilirubin (TSB) does not discriminate neonates at risk for auditory toxicity. Our objective was to compare TSB, bilirubin albumin molar ratio (BAMR), and unbound bilirubin (UB) for their association with chronic auditory toxicity in neonates with SHB (TSB ≥20 mg/dL or TSB that met criteria for exchange transfusion).
Infants ≥34 weeks' gestational age (GA) with SHB during the first 2 postnatal weeks were eligible for a prospective longitudinal study in India. Comprehensive auditory evaluations were performed at 2 to 3 months of age by using auditory brainstem response, tympanometry, and an otoacoustic emission test and at 9 to 12 months of age by using audiometry. The evaluations were performed by an audiologist unaware of the degree of jaundice.
A total of 93 out of 100 infants (mean GA of 37.4 weeks; 55 boys, 38 girls) who were enrolled with SHB were evaluated for auditory toxicity. Of those, 12 infants (13%) had auditory toxicity. On regression analysis controlling for covariates, peak UB (but not peak TSB or peak BAMR), was associated with auditory toxicity (odds ratio 2.41; 95% confidence interval: 1.43-4.07; .001). There was significant difference in the area under the receiver operating characteristic curves between UB (0.866), TSB (0.775), and BAMR (0.724) for auditory toxicity ( = .03) after controlling for covariates.
Unconjugated hyperbilirubinemia indexed by UB (but not TSB or BAMR) is associated with chronic auditory toxicity in infants ≥34 weeks' GA with SHB.
显著高胆红素血症（SHB）可能导致慢性听觉毒性（听觉神经病谱系障碍和/或感音神经性听力损失）；然而，血清总胆红素（TSB）无法区分有听觉毒性风险的新生儿。我们的目的是比较TSB、胆红素白蛋白摩尔比（BAMR）和未结合胆红素（UB）与SHB（TSB≥20mg/dL或符合换血标准的TSB）新生儿慢性听觉毒性的相关性。
出生后前两周内患有SHB且胎龄（GA）≥34周的婴儿符合在印度进行前瞻性纵向研究的条件。在2至3个月大时使用听觉脑干反应、鼓室图和耳声发射测试进行全面听觉评估，在9至12个月大时使用听力测定法进行评估。评估由一名不知道黄疸程度的听力学家进行。
100名患有SHB的入组婴儿（平均GA为37.4周；55名男孩，38名女孩）中，共有93名接受了听觉毒性评估。其中，12名婴儿（13%）有听觉毒性。在对协变量进行控制的回归分析中，UB峰值（而非TSB峰值或BAMR峰值）与听觉毒性相关（优势比2.41；95%置信区间：1.43 - 4.07；P = 0.001）。在对协变量进行控制后，UB（0.866）、TSB（0.775）和BAMR（0.724）用于听觉毒性的受试者工作特征曲线下面积存在显著差异（P = 0.03）。
以UB（而非TSB或BAMR）为指标的未结合高胆红素血症与GA≥34周的SHB婴儿的慢性听觉毒性相关。
