Impact of bilirubin-induced neurologic dysfunction on neurodevelopmental outcomes

Wusthoff, Courtney J.; Loe, Irene M.

doi:10.1016/j.siny.2014.12.003

Cited by 61 publications

(40 citation statements)

References 47 publications

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“…Poor developmental outcomes are likely to be a manifestation of hyperbilirubinaemia neurotoxicity, which causes brain injury to specific brain regions such as the frontal lobe, the cerebellum, basal ganglia, and the prefrontal cortex areas that are associated with language, motor, and socio-emotional functioning, respectively (Mwaniki, Atieno, Lawn, & Newton, 2012;Wusthoff & Loe, 2015).…”

Section: Developmental Outcomes In Nnjmentioning

confidence: 99%

Neonatal jaundice and developmental impairment among infants in Kilifi, Kenya

Magai

Mwaniki

Abubakar

et al. 2020

Child

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Background Neonatal jaundice (NNJ) is common in sub‐Saharan Africa (SSA), and it is associated with sepsis. Despite the high incidence, little has been documented about developmental impairments associated with NNJ in SSA. In particular, it is not clear if sepsis is associated with greater impairment following NNJ. Methods We followed up 169 participants aged 12 months (57 cases and 112 controls) within the Kilifi Health Demographic Surveillance System. The diagnosis of NNJ was based on clinical laboratory measurement of total serum bilirubin on admission, whereas the developmental outcomes were assessed using the Developmental Milestones Checklist and Kilifi Development Inventory. Results There were significant differences between the cases and controls in all developmental domains. Cases scored lower in language functioning (mean [M] = 6.5, standard deviation [SD] = 4.3 vs. M = 8.9, SD = 4.6; p < .001); psychomotor functioning (Mdn = 23, interquartile range [IQR] = 17–34 vs. Mdn = 31.0, IQR = 22.0–44.0; Mann–Whitney U = 4,122, p = .002); and socio‐emotional functioning ([Mdn = 30.0, IQR = 27.0–33.0 vs. Mdn = 34.0, IQR = 30.0–37.0], Mann–Whitney U = 4,289, p < .001). There was no evidence of association between sepsis and psychomotor (rpb = −.2, p = .214), language (rpb = −.1, p = .510), and socio‐emotional functioning (rpb = .0, p = .916). Significant and medium to large portions of the variance (34–64%) in the developmental outcomes among children who survived NNJ were associated with home birth, low maternal education, and feeding problems during the first days of life. Conclusions NNJ is associated with developmental impairments in the early childhood years; however, NNJ associated with sepsis does not lead to more severe impairment. Prenatal and postnatal care services are needed to reduce the negative impact of NNJ for children from low resourced settings.

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Section: Developmental Outcomes In Nnjmentioning

confidence: 99%

Neonatal jaundice and developmental impairment among infants in Kilifi, Kenya

Magai

Mwaniki

Abubakar

et al. 2020

Child

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“…Rather than applying phototherapy and exchange transfusions when necessary, the treatment of hyperbilirubinemia is a complex interplay of adequate screening of atrisk pregnancies, anticipation of the hyperbilirubinemic neonate, and the combination of antenatal and postnatal management. The importance of this interplay is also reflected in the nonlinear relationship between neonatal bilirubin levels and the risk of BIND and kernicterus and the wide variety of clinical manifestations, varying between neurodevelopmental difficulties (including developmental delay, cognitive impairment, and disordered executive function), and behavioral and psychiatric disorders [84].…”

Section: Bind and Kernicterusmentioning

confidence: 99%

Neonatal management and outcome in alloimmune hemolytic disease

Ree

Smits-Wintjens

Bom

et al. 2017

Expert Review of Hematology

103

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Introduction: Hemolytic disease of the fetus and newborn (HDFN) occurs when fetal and neonatal erythroid cells are destroyed by maternal erythrocyte alloantibodies, it leads to anemia and hydrops in the fetus, and hyperbilirubinemia and kernicterus in the newborn. Postnatal care consists of intensive phototherapy and exchange transfusions to treat severe hyperbilirubinemia and top-up transfusions to treat early and late anemia. Other postnatal complications have been reported such as thrombocytopenia, iron overload and cholestasis requiring specific management. Areas covered: This review focusses on the current neonatal management and outcome of hemolytic disease and discusses postnatal treatment options as well as literature on long-term neurodevelopmental outcome. Expert commentary: Despite major advances in neonatal management, multiple issues have to be addressed to optimize postnatal management and completely eradicate kernicterus. Except for strict adherence to guidelines, improvement could be achieved by clarifying the epidemiology and pathophysiology of HDFN. Several pharmacotherapeutic agents should be further researched as alternative treatment options in hyperbilirubinemia, including immunoglobulins, albumin, phenobarbital, metalloporphyrins, zinc, clofibrate and prebiotics. Larger trials are warranted to evaluate EPO, folate and vitamin E in neonates. Long-term follow-up studies are needed in HDFN, especially on thrombocytopenia, iron overload and cholestasis.ARTICLE HISTORY

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“…En los neonatos de mediano riesgo se han reportado secuelas a largo plazo que incluyen retrasos del desarrollo, dificultades escolares y, en casos más severos, retraso mental. 43 Aunque la bilirrubina sérica debe ser elevada para producir daño neurológico los estudios no son concluyentes. 1,44 También se ha observado que sus efectos pueden ser reversibles; 45 así, la hiperbilirrubinemia sería un factor necesario pero no suficiente para explicar el daño neuroló-gico que se produce en algunos recién nacidos.…”

Section: Factores Postnatalesunclassified

Riesgo neurológico en el niño de mediano riesgo neonatal

Vericat

Orden

2017

Acta Pediatr Mex

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255www.actapediatrica.org.mx Artículo de revisión Acta Pediatr Mex. 2017 jul;38(4):255-266. Riesgo neurológico en el niño de mediano riesgo neonatalResumen INTRODUCCIÓN: los neonatos de mediano riesgo suelen presentar alteraciones del neurodesarrollo, sutiles o inaparentes, que pueden evidenciarse a mediano y a largo plazos; es por ello que se les considera niños de riesgo neurológico. La identificación de los factores de riesgo asociados con los problemas del neurodesarrollo es un primer paso para prevenir o reducir sus efectos.OBJETIVO: con esta revisión cualitativa de la literatura especializada pretendemos describir las características de un grupo de neonatos denominados colectivamente recién nacidos de mediano riesgo neonatal y que, al nacer, no presentan compromiso evidente del desarrollo neurológico. Indagamos, también sobre los factores etiológicos asociados con esta condición. MATERIALES Y MÉTODOS:realizamos una búsqueda bibliográfica en las bases Scientific Electronic Library Online (SciELO), Literatura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS), la Biblioteca Nacional de Medicina de Estados Unidos de Norte América (NLM-Medline) y la Red de Revistas Científicas de América Latina y el Caribe, España y Portugal (RedALyC) centrada en factores de riesgo neurológico.RESULTADOS: el incremento de los controles prenatales, la reducción de los nacimientos pretérmino y del parto por cesárea son factores relevantes para el óptimo neurodesarrollo. Luego del parto es necesario extremar los cuidados del neonato en las Unidades de Cuidado Intensivo Neonatal controlando cuadros tales como la hiperbilirrubinemia, la sepsis neonatal y la dificultad respiratoria, asociados con alteraciones del desarrollo en los neonatos de mediano riesgo.CONCLUSIONES: las intervenciones para evitar o reducir el riesgo neurológico en los neonatos de mediano riesgo deben establecerse desde el inicio de la gestación y continuar durante toda la permanencia en las Unidades de Cuidado Intensivo Neonatal.PALABRAS CLAVE: recién nacido, trastornos del neurodesarrollo, factores de riesgo, neonatología, desarrollo infantil. OBJECTIVE:To describe the characteristics of a group of newborns collectively referred to as moderate-risk neonates, who at birth do not show neurodevelopmental disorders, and to investigate the etiological factors associated with this condition. METHODS:We carried a bibliographic search was performed in the SciELO, LILACS, Medline and RedALyC databases focused on neurological risk factors. RESULTS:Increased prenatal control and the reduction of preterm and cesarean delivery are important factors for optimal neurodevelopment. After delivery, newborn care in NICUs is critical, by controlling pathologies such as hyperbilirubinemia, neonatal sepsis, and respiratory distress associated with developmental abnormalities in MRN. CONCLUSIONS:Interventions to avoid or reduce neurological risk in MRN must be established from the beginning of pregnancy and continued during the NICU stay.

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Impact of bilirubin-induced neurologic dysfunction on neurodevelopmental outcomes

Cited by 61 publications

References 47 publications

Neonatal jaundice and developmental impairment among infants in Kilifi, Kenya

Neonatal jaundice and developmental impairment among infants in Kilifi, Kenya

Neonatal management and outcome in alloimmune hemolytic disease

Riesgo neurológico en el niño de mediano riesgo neonatal

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