Hearing and Neurological Impairment in Children with History of Exchange Transfusion for Neonatal Hyperbilirubinemia

Abstract

The objective was to determine frequency of sensorineural hearing loss (SNHL), identified by abnormal threshold in evoked potentials, absence of otoacoustic emissions and behavioral responses, auditory neuropathy (AN) (absence of evoked potentials, with preservation of otoacoustic emissions), and neurological comorbidity in infants with hyperbilirubinemia (HB) treated with exchange-transfusion (ET). From a total of 7,219 infants, ET was performed on 336 (4.6%). Inclusion criteria were fulfilled in 102; 234 children did not meet criteria (182 outside of the study period, 34 did not have complete audiological evaluation, and 18 rejected the followup). Thirty-five children (34%) were born at-term and 67 (66%) were preterm. Children had a mean age of 5.5 ± 3.9 years. Main causes of ET were Rh isoimmunization in 48 (47%), ABO incompatibility in 28 (27.5%), and multifactorial causes in 26 (25.5%). Fifteen (15%) children presented with SNHL. Preterm newborns presented more often with SNHL. Indirect bilirubin level was higher in children with SNHL (22.2 versus 18.7 mg/dL, P = 0.02). No cases of AN were documented. An increased risk of neurologic sequelae was observed in children with SNHL. In conclusion, we disclosed a high frequency of SNHL in children with neonatal HB and ET and neurological alterations. No cases of AN were observed.

Audiologic impairment associated with bilirubin-induced neurologic damage

“…However, in this study, there was no relationship between peak TB levels and ANSD, whereas a correlation was found in another study of >600 subjects [47]. Similarly, Martínez-Cruz et al [48] found that, of 102 children who underwent exchange transfusion for hyperbilirubinemia, 15% presented with sensorineural hearing loss by a mean age of 5.5 ± 3.9 years; they also had a higher unconjugated bilirubin level than their peers without hearing loss. Hearing loss at the time of documented hyperbilirubinemia (defined as TB >10-20 mg/dL, depending upon the study) was diagnosed by ABR or an automated ABR (AABR) in 9.0-73.3% of children [46,49–52], although the prevalence of hearing loss later in life (at 2 months to 2 years of age) was only 2-6.7% [52–54].…”

Exchange transfusion in initial phase of acute encephalopathy bilirubin of a 7-day old neonate: a case report

“…An increased risk of neurologic sequel was observed in children with SNHL. 24 In this case, exchange transfusion was done to the patient and the baby discharged home in good condition. A follow up for hearing impairment and development was scheduled to monitor longterm outcome.…”

Risk Factors for Congenital Hearing Loss: Which Are the Most Relevant?

“…According to several largescale studies on the subject, hyperbilirubinemia is generally accepted to be an important risk factor for congenital hearing loss. 17,18 Among those who did not receive any potentially ototoxic medication, 94.6% had a PASS result and 5.4% had a REFER result (3.6% for one ear, 1.8% for both ears), while among those who received potentially ototoxic medication (aminoglycosides and loop diuretics), only 76.9% had a PASS result and 23.1% had a REFER result (13.9% for one ear, 9.3% for both ears), the difference proving to be statistically significant (p <0.001).…”