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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Neonatal bilirubin exposure and psychoeducational outcome
R L Hansen1, G G Hughes, C E Ahlfors
1Department of Pediatrics, University of California, Davis, Sacramento 95817.
Insights
Neonatal intensive care unit survivors
Area of Science:
- Neonatal Medicine
- Developmental Psychology
- Pediatric Neurology
Background:
- Neonatal hyperbilirubinemia is common.
- High bilirubin levels can potentially cause brain damage.
- Long-term neurodevelopmental outcomes require further investigation.
Purpose of the Study:
- To investigate the association between neonatal bilirubin exposure and psychoeducational outcomes in school-aged children.
- To determine which measures of bilirubin exposure are most predictive of cognitive and behavioral function.
Main Methods:
- A cohort of 74 children who received neonatal intensive care were assessed at 9-11 years old.
- Psychoeducational outcomes were measured using the Kaufman Mental Processing and Achievement Scales, Beery Visual Motor Integration Test, and Vineland Adaptive Behavior Scale.
- Bilirubin binding was assessed using serum albumin concentration and direct bilirubin measures.
Main Results:
- A calculated measure of bilirubin binding, derived from albumin concentration, significantly correlated with the Kaufman Mental Processing Composite.
- Direct measures of bilirubin exposure (maximum serum bilirubin, direct binding, cumulative exposure) did not show significant correlations.
- Low serum albumin itself may impact neurodevelopmental outcomes, independent of bilirubin binding capacity.
Conclusions:
- Albumin-determined bilirubin binding may be a more relevant clinical indicator than total serum bilirubin for predicting psychoeducational outcomes.
- Further research is needed to elucidate the specific mechanisms by which low serum albumin affects neurodevelopment.
- Clinical management of neonatal hyperbilirubinemia may benefit from considering albumin levels alongside bilirubin concentrations.
Abstract:
The association between neonatal bilirubin exposure and psychoeducational outcome was investigated in a group of grade school children 9 to 11 years old who required neonatal intensive care between 1977 and 1980. Seventy-four children were evaluated with four measures of psychoeducational outcome, including the Kaufman Mental Processing and Achievement Scales, the Beery Visual Motor Integration Test, and the Vineland Adaptive Behavior Scale. A measure of bilirubin binding calculated directly from the albumin concentration correlated significantly with the Kaufman Mental Processing Composite, although other more direct measures of bilirubin exposure (such as maximum serum bilirubin, direct measures of binding, and cumulative bilirubin exposure) did not. Thus, it is possible that the impact on psychoeducational outcome is the result of some other effect of low serum albumin itself, in addition to its ability to bind bilirubin. The correlation of the calculated albumin-determined binding value with the Kaufman Mental Processing Composite suggests that this level, rather than total serum bilirubin, may be more appropriate in determining clinical management.
