Nam Gi-Sung, Kwak Sang Hyun, Bae Seong Hoon, Kim Sung Huhn, Jung Jinsei, Choi Jae Young
Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Chonbuk National University, Jeonju, Korea.
Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea.
Clin Exp Otorhinolaryngol. 2019 May;12(2):163-168. doi: 10.21053/ceo.2018.00899. Epub 2018 Nov 9.
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.
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.
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.
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.
新生儿高胆红素血症被认为是听力损失最常见的致病因素之一。早产儿更容易受到高胆红素血症引起的神经元损伤。本研究旨在通过连续听觉脑干反应（ABR）评估高胆红素血症对早产儿听力阈值和听觉通路的影响。此外，我们评估了与总血清胆红素（TSB）相比，未结合胆红素（UCB）水平在胆红素诱导的听力损失方面的作用。
本研究对70例通过自动ABR未能通过新生儿听力普遍筛查的高胆红素血症早产儿进行。诊断性ABR在出生后3个月内进行。对结果异常的患者（30例）进行随访ABR。根据ABR听力阈值比较TSB和UCB浓度。
诊断性ABR≥40 dB nHL组（n = 30）早产儿的初始和最大测量UCB浓度与ABR≤35 dB nHL组（n = 40）相比，差异有统计学意义（分别为P = 0.031和P = 0.003）。在随访ABR检查中，ABR≥40 dB nHL组中有13例显示完全恢复，但17例无变化或病情恶化。恢复组和未恢复组之间的胆红素水平无差异。
通过连续ABR评估，在早产儿中UCB比TSB更能预测胆红素诱导的听力损失。连续ABR检测可作为评估早产儿早期可逆性胆红素诱导的听力损失的一种有用的非侵入性方法。
