Bilirubin-Induced Audiologic Injury in Preterm Infants

Abstract

While hyperbilirubinemia is extremely common among neonates and is usually mild and transient, it sometimes leads to bilirubin-induced neurologic damage (BIND). The auditory pathway is highly sensitive to the effects of elevated total serum/plasma bilirubin (TB) levels, with damage manifesting clinically as auditory neuropathy spectrum disorder (ANSD). Compared to full-term neonates, preterm neonates are more susceptible to BIND and suffer adverse effects at lower TB levels with worse long-term outcomes. Furthermore, while standardized guidelines for management of hyperbilirubinemia exist for term and late-preterm neonates, similar guidelines exist for neonates less than 35 wks gestational age (GA) are limited.

Analysis on the MRI and BAEP Results of Neonatal Brain with Different Levels of Bilirubin

“…Auditory complications, a disabling neurological nding in kernicterus, are typically characterized by varying degree of auditory neuropathy/dys-synchrony (AN/AD) ranging from central auditory processing di culties with normal hearing to severe AN/AD with absent auditory brainstem responses, and possibly accompanying severe hearing loss and deafness. In fact, the brainstem cochlear nuclei are said to be one of the rst structures affected by elevated total bilirubin, followed by the auditory nerve [58,59] . So we performed hearing tests for the 103 patients with brainstem auditory evoked potential (BAEP) [60] devices.…”

“…Although neonatal jaundice is quite common, affecting 60%-80% of newborns overall [1] . Mainly, with the high accumulation of unconjugated bilirubin, severe patients (their bilirubin's concentration >20mg/dL) may suffer from bilirubinencephalopathy or kernicterus, and bilirubun-induced neurological dysfunction (BIND) [2] , which will cause permanent damage to the basal ganglia, hippocampus, hypothalamus, cerebellar neurons, brainstem [3,4] , etc. Clinical manifestation includes lethargy, poor response, fever, apnea, convulsion, auditory complications and so on [2] .…”

Change to Hearing Loss–Related Risks and Screening in Preterm Infants

“…28 However, some neonates with hyperbilirubinemia may develop bilirubin-induced neurologic dysfunction (BIND), including acute bilirubin encephalopathy, isolated neural pathway dysfunction and kernicterus. 29 Neuronal damage caused by bilirubin deposition is most likely to occur in specific regions, such as the basal ganglia, globus pallidus, hypothalamic nuclei, and hippocampus. 30 The auditory nerve pathway is very sensitive to the toxicity of bilirubin and can lead to slight or even complete HL.…”

Age-specific dynamics of the auditory function in the extremely premature babies

“…Известно, что улучшение слуха при изначально диагностированной СН у глубоко недоношенных младенцев может быть обусловлено нивелированием последствий гипербилирубинемии, а также, что более вероятно, продолжающимися процессами аксонального роста, синаптогенеза и миелинизации слухового пути, которые у таких детей часто запаздывают или имеют дефекты. Это может приводить к улучшению и даже к полной нормализации КСВП и, следовательно, периферической слуховой функции даже после достижения детьми ПКВ, соответствующего сроку нормальных родов [4,18,[19][20][21][22][23][24][25][26][27][28][29], что мы и наблюдали у наших пациентов. Следует помнить, что нормализация данных КСВП в таких случаях может происходить вплоть до 24 мес фактической жизни, и в связи с этим планировать инвазивные формы реабилитации таких детей (кохлеарную имплантацию, КИ) нужно с осторожностью [4,8,13,18,[30][31][32].…”