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How to Obtain Reliable Visual Event-related Potentials in Newborns
Published on: October 24, 2019
Visual evoked potentials in neonatal hyperbilirubinemia
Wen-Xiong Chen1, Virginia Wong
1Division of Neurodevelopmental Pediatrics, Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong, China.
Insights
Neonatal hyperbilirubinemia can affect infant brain development. This study found that visual pathway effects from high bilirubin levels or phototherapy were generally transient, with most infants showing normal development by age three.
Area of Science:
- Neonatalogy
- Neuroscience
- Ophthalmology
Background:
- Neonatal hyperbilirubinemia management is standardized, but objective measures for cerebral effects beyond auditory evoked potentials are lacking.
- Few studies have investigated the impact of hyperbilirubinemia and phototherapy on the visual pathway in neonates.
Purpose of the Study:
- To prospectively evaluate the effects of neonatal hyperbilirubinemia and phototherapy on the visual pathway using serial visual evoked potentials (VEPs).
- To assess neurodevelopmental outcomes in term neonates with varying degrees of hyperbilirubinemia up to three years of age.
Main Methods:
- Serial visual evoked potentials (VEPs) were recorded in two groups of term neonates (N=24): moderate (n=16) and severe (n=8) hyperbilirubinemia.
- Infants underwent regular physical, neurological, visual, and auditory evaluations until age 3.
- Comparison of VEPs between hyperbilirubinemia groups and assessment of phototherapy's impact.
Main Results:
- Four infants (16%) exhibited abnormal VEPs before age one, which normalized subsequently.
- No significant differences in VEPs were observed between moderate and severe hyperbilirubinemia groups.
- All infants achieved normal neurodevelopmental status by age three, with one exception in the severe group (ABO incompatibility) who had transient motor delay, hypotonia, and abnormal VEPs.
- Phototherapy did not show abnormal long-term effects on VEPs.
Conclusions:
- The effects of neonatal hyperbilirubinemia on visual evoked potentials appear to be transient.
- Neurodevelopmental outcomes are generally favorable despite transient visual pathway abnormalities.
- Further research with larger sample sizes is warranted to confirm these findings.
Abstract:
The management of neonatal hyperbilirubinemia is very standardized. However, there is a lack of an objective method to evaluate the cerebral effects of bilirubin apart from brainstem auditory evoked potentials. There were few studies evaluating the effects of hyperbilirubinemia or phototherapy on the visual pathway in infants with hyperbilirubinemia. Serial visual evoked potentials of two groups of term neonates (N = 24)--group 1 with moderate hyperbilirubinemia (n = 16) and group 2 with severe hyperbilirubinemia (n = 8)--were evaluated prospectively. All infants had regular physical, neurologic, visual, and auditory evaluations until 3 years. Four (16%) had abnormal visual evoked potentials before 1 year, and the abnormalities returned to normal thereafter. There was no significant difference in visual evoked potentials between the two groups. All had normal neurodevelopmental status by 3 years, with the exception of one child from the severe group with ABO incompatibility with transient mild motor delay, hypotonia, and abnormal visual evoked potential. There were no abnormal effects of phototherapy on visual evoked potentials in infants with neonatal hyperbilirubinemia after 1 year of age. Although our sample size was small, the results suggest that the effects of hyperbilirubinemia on visual evoked potentials might be transient. (J Child Neurol 2006;21:58-62).
