De Vries L S, Lary S, Whitelaw A G, Dubowitz L M
Department of Paediatrics and Neonatal Medicine, Hammersmith Hospital, London, U.K.
Early Hum Dev. 1987 Sep;15(5):269-77. doi: 10.1016/0378-3782(87)90050-8.
A comparison has been made between 39 infants with a birthweight of 1500 g or less and a bilirubinlevel of 240 mumol/l or above, born between January 1980 and December 1983 and 19 infants with the same criteria, born between January 1984 and December 1985. Eight of the 22 high risk and two of the 17 low risk infants were diagnosed to have sensorineural deafness (SND) during the first period and this was strongly associated with the duration of the hyperbilirubinaemia. During the second period, more active intervention for hyperbilirubinaemia led to an increased number of exchange transfusions and a marked drop in the mean duration of hyperbilirubinaemia (less than 240 mumol/l). None of the very low birth weight (VLBW) infants born in the second period have developed SND. To investigate the independent effect of hyperbilirubinaemia on hearing, six low risk infants with bilirubin levels less than 320 mumol/l were studied by serial auditory brainstem responses (ABR). Impairment of the ABRs was found in four infants, with further deterioration with the persistence of high bilirubin levels in two. Although recovery of hearing thresholds was noted in all infants with impaired ABRs, an absence of wave I was noted in three infants at 6 months of age, which could indicate damage to the auditory nerve-cochlear complex. These findings suggest that hyperbilirubinaemia in itself can have an adverse effect on hearing and that careful management of hyperbilirubinaemia may reduce the incidence of sensorineural deafness.
对1980年1月至1983年12月出生、出生体重1500克及以下且胆红素水平在240μmol/l及以上的39名婴儿与1984年1月至1985年12月出生、符合相同标准的19名婴儿进行了比较。在第一阶段，22名高危婴儿中有8名、17名低危婴儿中有2名被诊断患有感音神经性耳聋（SND），这与高胆红素血症的持续时间密切相关。在第二阶段，对高胆红素血症采取了更积极的干预措施，导致换血次数增加，高胆红素血症的平均持续时间显著下降（低于240μmol/l）。第二阶段出生的极低出生体重（VLBW）婴儿均未发生SND。为研究高胆红素血症对听力的独立影响，对6名胆红素水平低于320μmol/l的低危婴儿进行了系列听性脑干反应（ABR）研究。4名婴儿出现ABR损害，其中2名婴儿随着高胆红素水平的持续存在病情进一步恶化。尽管所有ABR受损的婴儿听力阈值均有恢复，但6个月大时3名婴儿出现I波缺失，这可能表明听神经 - 耳蜗复合体受损。这些发现表明，高胆红素血症本身可对听力产生不利影响，谨慎处理高胆红素血症可能会降低感音神经性耳聋的发生率。
