Evaluation of Auditory Brain Stems Evoked Response in Newborns with Pathologic Hyperbilirubinemia in Mashhsd, Iran

Abstract

Background:Neonatal jaundice is a common cause of sensorneural hearing loss in children.Objectives:We aimed to detect the neurotoxic effects of pathologic hyperbilirubinemia on brain stem and auditory tract by auditory brain stem evoked response (ABR) which could predict early effects of hyperbilirubinemia.Patients and Methods:This case-control study was performed on newborns with pathologic hyperbilirubinemia. The inclusion criteria were healthy term and near term (35 - 37 weeks) newborns with pathologic hyperbilirubinemia with serum bilirubin values of ≥ 7 mg/dL, ≥ 10 mg/dL and ≥14 mg/dL at the first, second and third-day of life, respectively, and with bilirubin concentration ≥ 18 mg/dL at over 72 hours of life. The exclusion criteria included family history and diseases causing sensorineural hearing loss, use of auto-toxic medications within the preceding five days, convulsion, congenital craniofacial anomalies, birth trauma, preterm newborns < 35 weeks old, birth weight < 1500 g, asphyxia, and mechanical ventilations for five days or more. A total of 48 newborns with hyperbilirubinemia met the enrolment criteria as the case group and 49 healthy newborns as the control group, who were hospitalized in a university educational hospital (22 Bahaman), in a north-eastern city of Iran, Mashhad. ABR was performed on both groups. The evaluated variable factors were latency time, inter peak intervals time, and loss of waves.Results:The mean latencies of waves I, III and V of ABR were significantly higher in the pathologic hyperbilirubinemia group compared with the controls (P < 0.001). In addition, the mean interpeak intervals (IPI) of waves I-III, I-V and III-V of ABR were significantly higher in the pathologic hyperbilirubinemia group compared with the controls (P < 0.001). For example, the mean latencies time of wave I was significantly higher in right ear of the case group than in controls (2.16 ± 0.26 vs. 1.77 ± 0.15 milliseconds, respectively) (P < 0.001).Conclusions:Pathologic hyperbilirubinemia causes acute disorder on brain stem function; therefore, early diagnosis of neonatal jaundice for prevention of bilirubin neurotoxic effects is essential. As national neonatal hearing screening in not yet established in Iran, we recommend performing ABR for screening of bilirubin neurotoxicity in all cases with hyperbilirubinemia.

Hyperbilirubinemia impact on newborn hearing: a literature review

“…Papers excluded due to low quality 2 one 16 was published in Spanish, while the others were published in English. The sample sizes varied from 25 to 71 neonates (average of 39.7 subjects per study), with a predominance of male infants in 80% of the studies in which this data was specified 3,13,15,16 .…”

Congenital Deafness and Recent Advances Towards Restoring Hearing Loss

“…Jaundice is a common perinatal problem created when the bilirubin contained in red blood cells is present in excess amounts in the blood due to a temporary lack of clearance by the liver. This hyperbilirubinemia that occurs during the first week after birth is present in 60% to 84% of newborns and usually clears on its own ( Bhutani et al, 2013 ; Okhravi, Tarvij Eslami, Hushyar Ahmadi, Nassirian, & Najibpour, 2015 ). However, 7% of newborns require a phototherapy treatment or in severe cases an exchange transfusion to avoid neurological injury.…”

“…Toxicity occurs when the increased concentration of bilirubin in the blood is superior to the albumin binding capacity. This unconjugated bilirubin diffuses across the blood-brain barrier and the cell membrane to create neuroinflammation ( Okhravi et al, 2015 ; Olds & Oghalai, 2015 ; Zucker, Goessling, & Hoppin, 1999 ). Previous studies highlight the production of oxidative stress and endoplasmic-reticulum stress (ER-stress) as a cause of the neuronal toxicity ( Schiavon, Smalley, Newton, Greig, & Forsythe, 2018 ; Vodret et al, 2018 ).…”

Transient evoked otoacoustic emissions and auditory brainstem response in infants with perinatal asphyxia

“…The first evaluates the integrity of the outer hair cells (OHC) [7,8]. The second checks the integrity of the auditory pathway and estimates the auditory threshold [9].…”