Besli Gulser Esen, Metin Fazilet, Aksit Mehmet Ateş, Saltik Sema
Istanbul Medeniyet University Faculty of Medicine Goztepe Training and Research Hospital Department of Pediatrics, Istanbul, Turkey.
Erdem Hospital Camlica, Clinics of Neonatology, Istanbul, Turkey.
Medeni Med J. 2020;35(1):29-39. doi: 10.5222/MMJ.2020.26986. Epub 2020 Feb 28.
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 hyperbilirubinemia.
This study was performed prospectively in 41 term newborns hospitalized for indirect hyperbilirubinemia. 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.
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).
This study demonstrates that kernicterus may develop in term newborns with severe hyperbilirubinemia (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.
本研究旨在调查新生儿间接高胆红素血症对其他方面健康的足月儿神经和听力功能的长期影响。
本研究对41例因间接高胆红素血症住院的足月儿进行了前瞻性研究。无溶血迹象的患者根据稳定水平分为3组，即血清总胆红素（sTB）<20mg/dl、20 - 24.9mg/dl和≥25mg/dl。总胆红素水平≥20mg/dl且患有溶血病的患者被归为第四组。研究了最高sTB水平、sTB水平>20mg/dl的暴露持续时间以及黄疸病因与神经和听觉功能之间的关系。在所有患者18 - 24个月大时进行了详细的神经检查、丹佛发育筛查测验Ⅱ以及听力测试（耳声发射，OAE和听觉脑干反应，ABR）。
5例（12.2%）患者发现神经发育障碍。其中2例患者检测出溶血病。4例（9.8%）患者发现听力损失。其中2例患者患有听神经病谱障碍，另外2例患有耳蜗性听力损失。所有这些患者的sTB水平均高于25mg/dl。sTB水平<25mg/dl的患者未发现神经障碍或听力损失。神经功能障碍和ABR结果异常的患者，其sTB水平高于20mg/dl的暴露时间显著更长（p:0.007，p:0.007；p<0.05）。
本研究表明，在无明显溶血迹象的重度高胆红素血症（sTB>25mg/dl）足月儿中可能发生核黄疸。不仅胆红素水平，而且高胆红素水平的暴露持续时间可能对胆红素神经毒性的发生有影响。我们患者中听力损失的高发生率强调了对重度高胆红素血症婴儿进行全面听觉评估筛查以早期诊断可能的听力损失的重要性。
