Toxicity to bilirubin in neonates: Infant development during first year in relation to maximum neonatal serum bilirubin concentration

Scheidt, Peter C.; Mellits, E. David; Hardy, Janet B.; Drage, Joseph S.; Boggs, Thomas R.

doi:10.1016/s0022-3476(77)80835-4

Cited by 127 publications

(38 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…If the clinician does not agree with the risk-benefit profile on which the guideline is based or does not anticipate the occurrence of the adverse outcomes being addressed by the guideline, then there may be resistance to adhere to the guideline. Although some studies [21][22][23][24][25] have found associations between serum bilirubin and neurodevelopmental outcomes, none has shown any long-term beneficial effects of phototherapy. 26 -28 Thus, the primary rationale for phototherapy must be to keep the bilirubin from rising to a level at which there is an increased risk of kernicterus.…”

Section: Discussionmentioning

confidence: 99%

Phototherapy Use in Jaundiced Newborns in a Large Managed Care Organization: Do Clinicians Adhere to the Guideline?

Atkinson

Escobar

Takayama³

et al. 2003

Pediatrics

View full text Add to dashboard Cite

ABSTRACT. Objective. In 1994, the American Academy of Pediatrics (AAP) published a practice guideline with age-specific thresholds for phototherapy for healthy term newborns with hyperbilirubinemia. The purpose of this study was to examine adherence to the guideline in a large managed care organization.Methods. We conducted a retrospective cross-sectional analysis of linked computerized databases from 11 Northern California Kaiser Permanente Medical Care Program hospitals. Newborn infants included were at least 37 weeks of gestation, had birth weights of at least 2500 g, and were born between January 1, 1995, and December 31, 1996. The primary outcome variable for the study was receipt of phototherapy according to the guideline. Total serum bilirubin (TSB) and infant age in hours at the time of bilirubin measurement were used to classify infants into 3 groups according to the AAP guideline: recommend phototherapy (R), consider phototherapy (C), and did not recommend phototherapy (N). Group R included infants with TSB levels of at least 15 mg/dL before 48 hours of age, at least 18 mg/dL before 72 hours, or at least 20 mg/dL after 72 hours. Group C included infants not in group R, with TSB levels of at least 12 mg/dL before 48 hours, 15 mg/dL before 72 hours, or at least 17 mg/dL after 72 hours. Group N included infants who were in neither group R nor group C and also did not have significant jaundice before 24 hours of age. Phototherapy codes from electronic databases were validated by chart review for a subset of 550 infants.Results. Compared with chart review, phototherapy codes in the database were 94.4% sensitive (95% confidence interval [CI]: 89.1%-97.5%) and 100% specific (95% CI: 99.25%-100%). Among the 47 801 infants eligible, 2.3% received phototherapy. Phototherapy was administered to 54% of 1194 infants in group R (range across hospitals: 27%-77%), 16% of 2245 infants in group C (range: 5%-37%), and 0.2% of 44 362 infants in group N (range: 0.1%-0.6%). The predictors of phototherapy for group R, the group for whom phototherapy was recommended, determined by logistic regression were increasing TSB levels (odds ratio [OR]: 1.6/mg/dL; 95% CI: 1.4 -1.7), reaching the AAP threshold at 24 to 47.9 hours of age compared with 48 hours or more (OR: 7.1; 95% CI: 4.3-11.9), gestational age of 37 weeks compared with 38 weeks or more (OR: 1.6; 95% CI: 1.1-2.3), age when phototherapy was first recommended (OR: 0.7/d; 95% CI: 0.6 -0.8), and facility of birth (OR: 0.2-2.7). The facility of birth was a strong predictor of phototherapy use in all groups (R, C, and N).Conclusions. Clinicians provided phototherapy to only 54% of term infants with hyperbilirubinemia for whom it was recommended by the AAP. There is marked interhospital variation in phototherapy use in this large managed care system. Improved adherence to the guideline would require only a slight increase in the total rate of phototherapy use if unnecessary use for infants with lower levels of TSB were simultaneously decreased. I n 1994, the American Academy ...

show abstract

Section: Discussionmentioning

confidence: 99%

Phototherapy Use in Jaundiced Newborns in a Large Managed Care Organization: Do Clinicians Adhere to the Guideline?

Atkinson

Escobar

Takayama³

et al. 2003

Pediatrics

View full text Add to dashboard Cite

show abstract

“…These risk factors include positive family history, hyperbilirubinemia, exposure to ototoxic medications, hypoxia, birth asphyxia and intracranial hemorrhages, including intraventricular hemorrhage. [2][3][4][5][6][7] The exact anatomical location of abnormality or injury and the pathophysiology of AN are poorly understood. As such, there are no specific risk factors to distinguish AN from cochlear hearing loss.…”

Section: Introductionmentioning

confidence: 99%

Extremely low birth weight infants are at high risk for auditory neuropathy

et al. 2007

View full text Add to dashboard Cite

Auditory neuropathy (AN) is a condition in which transmission of sound to the brain is abnormal. This is reflected as an electrophysiologic profile of normal otoacoustic emissions (OAE), with abnormal auditory brainstem evoked responses (ABR). Functionally speech perception is impaired and management strategies remain controversial. AN can be missed if high-risk newborns are screened for hearing loss with only OAE testing. The rate of sensorineural hearing loss (SNHL) in high-risk nursery infants is 10 times greater compared with normal term newborns. Therefore, we hypothesize that infants from the neonatal intensive care unit (NICU) are at significantly higher risk for AN than normal term infants.Objective: The objective of this study is to establish a prevalence rate and characterize risk factors for NICU graduates who demonstrate the AN electrophysiologic profile.Study Design: This retrospective study examined infants admitted to the NICU at Kapi'olani Medical Center for Women and Children in Honolulu, HI from 1999 through 2003. Infants were screened with automated ABR. Diagnostic testing and OAE were performed before discharge if the ABR was abnormal. Hospital courses of 24 AN, 71 SNHL and 95 gestational age (GA)-matched control infants with normal hearing were reviewed.Result: With a SNHL prevalence of 16.7/1000, the rate for AN was 5.6/1000 NICU infants. Compared to infants with SNHL, infants with AN were significantly younger (GA 28.3±4.8 AN vs 32.9±5.2 weeks SNHL, P<0.0001) and smaller (BW 1318±894 AN vs 1968±1006 g SNHL).Nearly two-thirds of the AN infants were ELBW and had significantly longer hospital stays compared to SNHL infants of the same birth weight group. Exposure to furosemide, aminoglycosides, vancomycin or dexamethasone was associated with increased AN but not SNHL. Peak bilirubin level correlated with SNHL but not AN.Conclusion: Low birth weight NICU infants are at significant risk for AN. ELBW infants are at significantly higher risk for both AN and SNHL.Infants admitted to the NICU should be routinely screened by automated ABR and if abnormal, further evaluation should be started before hospital discharge. Early identification of AN will result in better understanding of this disorder and lead to the development of appropriate intervention strategies.

show abstract

“…The difference in prevalence in relation to gestational age not found significant. In contrast to these, other studies like Scheidt et al (12) reported significant relationship of gestational age and neurodevelopmental abnormalities which were more in babies with low gestational age, Wolf et al reported that neurodevelopmental abnormalities were more in those hyper-bilirubinemic neonates who were having lower gestational age. (8) Prevalence of abnormal neurodevelopmental outcome in neonates having peak serum bilirubin (PSB) >25mg/dl was 37.5% and 25% in follow ups at 3 months and 12 months.…”

Section: Discussionmentioning

confidence: 74%

A study of predictors & prevalence of neurodevelopmental outcome in hyper-bilirubinemic neonates admitted in NICU

2016

IJN

View full text Add to dashboard Cite

Background: Hyper-bilirubinemia may be toxic to the developing central nervous system and may cause neurological impairment. This study was conducted to identify factors of abnormal neurodevelopment at 3 & 12 months in babies having birth weight >1.5 kg and gestational age >34 weeks with neonatal hyper-bilirubinemia. Methods: This prospective study was conducted at Sardar Patel Medical College, Bikaner (Rajasthan) from 2014 to 2015. Hyper-bilirubinemic newborns were examined at 3 and 12 month age and their neurodevelopmental assessment was done by DASII method. All the collected data was tabulated and statically analyzed by using SPSS software. Results: 69.79% of hyper-bilirubinemic neonates were males & 30.21% were females. The prevalence of neurodevelopmental abnormalities (DQ≤70) was 10.42% at 3 months where as it was 6.25% at 12 months follow up suggesting reversibility of adverse neurodevelopment. Early onset of jaundice (≤1 day), serum bilirubin level >25 mg/dl, duration of hospital stay>3 days and requirement of exchange transfusion was significantly associated with adverse neurodevelopmental outcomes (DQ≤70) at 3 and 12 months of age on follow up. Conclusion: This Prospective observational study found a high prevalence of adverse neurodevelopmental outcome in neonates with hyper-bilirubinemia with risk factors. Early detection of neurodevelopmental abnormalities and initiation of early intervention measures to reduce the prevalence of neurodevelopmental abnormalities in hyper-bilirubinemic neonates.

show abstract

Toxicity to bilirubin in neonates: Infant development during first year in relation to maximum neonatal serum bilirubin concentration

Cited by 127 publications

References 6 publications

Phototherapy Use in Jaundiced Newborns in a Large Managed Care Organization: Do Clinicians Adhere to the Guideline?

Phototherapy Use in Jaundiced Newborns in a Large Managed Care Organization: Do Clinicians Adhere to the Guideline?

Extremely low birth weight infants are at high risk for auditory neuropathy

A study of predictors & prevalence of neurodevelopmental outcome in hyper-bilirubinemic neonates admitted in NICU

Contact Info

Product

Resources

About