The spectrum of bilirubin neurotoxicity in term and near-term babies with hyperbilirubinemia: Does outcome improve with time?

ElTatawy, Sarah; Elmazzahy, Esraa; Shennawy, Amira M. El; Madani, Hanan; Youssef, Hazem; Iskander, Iman

doi:10.1016/j.earlhumdev.2019.104909

Cited by 8 publications

(5 citation statements)

References 26 publications

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“…Existing studies have linked untreated severe neonatal jaundice requiring phototherapy or exchange transfusion with poorer neurological outcomes and cognitive abilities later in childhood. Children may have deficits in fine motor skills, language development, memory, attention, and visuospatial processing (14). Our study results were consistent with these findings.…”

Section: Discussionsupporting

confidence: 91%

The Relationship Between Perinatal and Postnatal Factors and Cognitive Development of Healthy Toddlers

Behmadi,

Dehvari,

Bakhshani

et al. 2023

J Compr Ped

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Background: Cognitive development during childhood has significant implications for an individual's cognitive functioning throughout life. Perinatal and postnatal factors may influence this function. Objectives: In this study, we aimed to investigate the relationship between perinatal and postnatal factors and cognitive development in healthy toddlers aged 18 – 22 months. Methods: In this retrospective cross-sectional study, we examined 50 toddlers born between March 2015 and March 2016 at a teaching hospital in Zahedan, Iran. This study focused on perinatal and neonatal risk factors based on the results of the Bayley-3 test. Data were analyzed using Mann–Whitney U, Kruskal–Wallis, and Pearson correlation coefficient tests. Results: Analysis revealed significant correlations between several perinatal factors and subsequent cognitive performance in toddlers. Greater maternal chronological age at the time of parturition, higher levels of mother's attained education, increased neonatal weight at delivery, augmented body weight in the toddler phase, as well as the documented occurrence of neonatal hyperbilirubinemia within the initial postpartum period, demonstrated meaningful associations with enhanced cognitive functioning as assessed during the toddler stage of development. Conclusions: Based on the results, it is advised that pregnancy commences at a maternal age that circumvents risks of very young childbearing. Offspring growth should be closely tracked, and neonatal jaundice promptly treated, as these perinatal factors impact cognitive performance. Giving priority to these factors improves a child's chances of healthy cognitive development, which is essential for success in life.

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Section: Discussionsupporting

confidence: 91%

The Relationship Between Perinatal and Postnatal Factors and Cognitive Development of Healthy Toddlers

Behmadi,

Dehvari,

Bakhshani

et al. 2023

J Compr Ped

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“…ElTatawy and colleagues [29] confirmed that a cut off TSB ≥ 27.5 mg/dl was found to detect kernicterus and auditory impairment at 1 year of age (100% sensitive, 76% specific). They found that poor neurodevelopmental outcome as well as auditory impairment was positively correlated to high TSB, high BIND score, and longer duration of exposure to severe hyperbilirubinemia.…”

Section: Discussionmentioning

confidence: 94%

Can bilirubin/albumin ratio predict neurodevelopmental outcome in severe neonatal hyperbilirubinemia? A 3-month follow up study

Soliman

Iskander

Elmazzahy

et al. 2021

Egypt Pediatric Association Gaz

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Background The risk of kernicterus and BIND may be in part determined by total serum bilirubin (TSB) and by the level of non-albumin bound free bilirubin, which can easily pass the blood–brain barrier. Free bilirubin (Bf) seems a more reliable predictor for bilirubin neurotoxicity. Bilirubin/albumin ratio (B/A) is considered a surrogate parameter for Bf and has been more useful than TSB. The aim of the study is to determine whether B/A ratio correlates with BIND in newborns with severe hyperbilirubinemia and if it can predict poor neurologic outcome at 3 months follow up. Results This prospective study included one hundred seventeen outborn neonates ≥ 35 weeks admitted in a tertiary care neonatal intensive care unit, between May and December 2012, with TSB ≥ 20 mg/dl or necessitating exchange transfusion. Total serum bilirubin and serum albumin were done on admission and bilirubin/albumin ratio was calculated. BIND score was calculated. At the age of 3 months, 112 neonates were followed up with a detailed neurological assessment. Babies who depicted any abnormal motor examination were subjected to brain stem auditory evoked response and MRI examination. Seven infants (6.2%) presented with kernicterus on follow up. BIND scores on admission, mean TSB, and bilirubin/albumin ratio was significantly higher in kernicteric infants compared with those having normal neurological outcome at 3 months of age (P 0.001). The lowest TSB level at which kernicterus occurred in our study was 31 mg/dl. Receiver operation characteristics analysis identified B/A ratio cut off value for predicting kernicterus of 9.6 with sensitivity of 100% and specificity of 91.4%, whereas TSB cut off value of 30 mg/dl showed sensitivity of 100% and specificity of 83%. Conclusion B/A ratio is a strong indicator for the risk of kernicterus. B/A is more specific than TSB and should be used in the early management of neonatal hyperbilirubinemia.

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“…Moreover, longitudinal studies have found no consistent correlation between neurologic abnormality and total serum bilirubin level >342 μmol/L. [29][30][31] Studies have documented occurrence of bilirubin-induced neurologic dysfunction at total serum bilirubin levels <342 μmol/L, 32 which may be explained by the fact that the level of indirect bilirubin between 71 and 770 μmol/L may lead to neurotoxicity. 33 Therefore, the sole use of clinical manifestations and total serum bilirubin level for diagnosis of acute bilirubin encephalopathy may lead to treatment delay, increasing the risk of severe neurologic damage.…”

Section: Discussionmentioning

confidence: 99%

Diagnostics Value of Quantitative Magnetic Resonance Imaging (MRI) in Neonatal Acute Bilirubin Encephalopathy

Liu

Zhang

et al. 2023

J Child Neurol

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Background: This study was designed to investigate the diagnostic value of relative signal intensity of globus pallidus on T1-weighted magnetic resonance imaging (MRI) in neonatal acute bilirubin encephalopathy (ABE). Methods: Participants who were recruited in hospital from April 2019 to May 2020 were grouped into mildly increased total serum bilirubin (TSB) group (n = 30), severely increased TSB group (n = 25), or extremely increased TSB group (n = 10) based on the total serum bilirubin level. Bilirubin-induced neurologic dysfunction scale score was used to determine if participants had acute bilirubin encephalopathy. All neonates underwent conventional brain MRI and the relative signal intensity of globus pallidus was measured on T1-weighted images. The diagnostic value of these 3 indices was assessed by receiver operating characteristic curve analysis. Results: There was a significant correlation between relative signal intensity of globus pallidus and total serum bilirubin level in neonates with hyperbilirubinemia (r = 0.551, P < .001). Relative signal intensity of globus pallidus in the extremely increased TSB group was significantly higher than that in severely increased TSB, mildly increased TSB, and healthy control groups. Relative signal intensity of globus pallidus in the acute bilirubin encephalopathy group was significantly higher than that in the non-acute bilirubin encephalopathy group ( P < .01). The area under the receiver operating characteristic curve of the relative signal intensity of globus pallidus was 0.765 ( P < .01), with sensitivity of 0.655 and specificity of 0.861. The area under the curve of the total serum bilirubin and visual inspection of globus pallidus signal was 0.621 and 0.579, respectively. The area under the curve of relative signal intensity was significantly greater than that of total serum bilirubin and visual inspection ( P = .04 for both). Conclusion: Relative signal intensity of globus pallidus, which is an objective assessment, has the potential to be used as a diagnostic tool for acute bilirubin encephalopathy.

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The spectrum of bilirubin neurotoxicity in term and near-term babies with hyperbilirubinemia: Does outcome improve with time?

Cited by 8 publications

References 26 publications

The Relationship Between Perinatal and Postnatal Factors and Cognitive Development of Healthy Toddlers

The Relationship Between Perinatal and Postnatal Factors and Cognitive Development of Healthy Toddlers

Can bilirubin/albumin ratio predict neurodevelopmental outcome in severe neonatal hyperbilirubinemia? A 3-month follow up study

Diagnostics Value of Quantitative Magnetic Resonance Imaging (MRI) in Neonatal Acute Bilirubin Encephalopathy

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