Related Experiment Video
Updated: Apr 5, 2026
Neuro-rehabilitation Approach for Sudden Sensorineural Hearing Loss
Published on: January 25, 2016
Risk of Sensorineural Hearing Loss and Bilirubin Exchange Transfusion Thresholds
Andrea C Wickremasinghe1, Robert J Risley2, Michael W Kuzniewicz3
1Department of Pediatrics, Kaiser Permanente Northern California, Santa Clara, California; Departments of Epidemiology & Biostatistics, andrea.wickremasinghe@kp.org.
Insights
Very high bilirubin levels in newborns significantly increase the risk of sensorineural hearing loss (SNHL). Lower bilirubin levels, even those near exchange transfusion thresholds (ETT), pose a minimal excess risk of SNHL.
Area of Science:
- Neonatal care
- Pediatric audiology
- Public health
Background:
- Elevated bilirubin levels in newborns are a known risk factor for sensorineural hearing loss (SNHL).
- Limited large-scale studies have quantified the precise risk associated with bilirubin levels near exchange transfusion thresholds (ETT).
Purpose of the Study:
- To determine the risk of SNHL in newborns with bilirubin levels at or above the American Academy of Pediatrics' ETT.
- To quantify the relative and excess risk of SNHL associated with varying degrees of hyperbilirubinemia.
Main Methods:
- A nested double cohort study included over 525,000 infants born at ≥35 weeks gestation.
- Infants with bilirubin levels at or above ETT were compared to a random sample of infants with levels below ETT.
- Audiologists reviewed charts to confirm SNHL diagnoses before age 8, blinded to bilirubin levels.
Main Results:
- A statistically significant increased risk of SNHL was observed only for bilirubin levels ≥10 mg/dL above ETT (HR: 36) and ≥35 mg/dL above ETT (HR: 91).
- For bilirubin levels 0-4.9 mg/dL above ETT, the excess risk of SNHL was less than 0.5%.
Conclusions:
- Only markedly elevated bilirubin levels, significantly exceeding ETT, are associated with a substantial risk of SNHL.
- The excess risk of SNHL is low for infants with bilirubin levels closer to, but not exceeding, ETT.
Background And Objectives:
High bilirubin levels are associated with sensorineural hearing loss (SNHL). However, few large studies of relative and excess risk exist. We sought to quantify the risk of SNHL in newborns who had bilirubin levels at or above American Academy of Pediatrics exchange transfusion thresholds (ETT).
Methods:
Infants born at ≥35 weeks gestation in 15 Kaiser Permanente Northern California hospitals from 1995-2011 were eligible (N = 525 409). We used a nested double cohort design. The exposed cohort included subjects with ≥1 bilirubin level at or above ETT. The unexposed cohort was a 3.6% random sample of subjects with all bilirubin levels below ETT (10 unexposed per exposed). An audiologist, blinded to bilirubin levels, reviewed the charts of children in whom SNHL had been diagnosed before age 8 years to confirm the diagnosis. We calculated Cox proportional hazard ratios for time to diagnosis of SNHL.
Results:
SNHL was confirmed in 11 (0.60%) of the 1834 exposed subjects and in 43 (0.23%) of the 19 004 unexposed. Only bilirubin levels ≥10 mg/dL above ETT were associated with a statistically significant increased risk of SNHL (hazard ratio: 36 [95% confidence interval (CI): 13 to 101]). Likewise, only bilirubin levels ≥35 mg/dL were associated with a statistically significant increased risk of SNHL (hazard ratio: 91 [95% CI: 32 to 255]). For subjects with total serum bilirubin levels 0 to 4.9 mg/dL above ETT, the upper limit of the 95% CI for excess risk was 0.5%.
Conclusions:
Only bilirubin levels well above ETT were associated with SNHL. At lower bilirubin levels, the excess risk of SNHL was low.
More Related Videos
Related Concept Videos
01:22Effect of Hepatic Disease on Pharmacokinetics: Pathophysiologic Assessment and Liver Function Test
01:26Effect of Hepatic Disease on Pharmacokinetics: Drug Dosing and Hepatic Blood Flow
02:45Blood Transfusion and Agglutination
History
The history of blood transfusion dates back to the 17th century, when early attempts were made in animals. In 1818 James Blundell, a British doctor, performed the first successful human blood transfusion. Later in 1900, Karl...
01:27Pharmacogenetics of Phase II Enzymes: N-acetyltransferase, Thiopurine S-methyltransferase, UDP-glucuronosyltransferase
01:15Blood Transfusion
Blood Transfusion Overview
A blood transfusion is a medical procedure used to replace blood lost due to injury, surgery, or to treat conditions such as anemia or cancer. During a transfusion, donor blood is...
01:08Effect of Hepatic Disease on Pharmacokinetics: Dose Adjustments Due to Hepatic Impairment