Chronic Auditory Toxicity in Late Preterm and Term Infants With Significant Hyperbilirubinemia
Sanjiv B Amin1, Satish Saluja2, Arvind Saili3
1Departments of Pediatrics, sanjiv_amin@urmc.rochester.edu.
Insights
Unbound bilirubin (UB) levels, not total serum bilirubin (TSB) or bilirubin albumin molar ratio (BAMR), effectively identify neonates at risk for significant hyperbilirubinemia (SHB) and subsequent chronic auditory toxicity. This finding is crucial for early intervention in newborns.
Area of Science:
- Neonatal Medicine
- Auditory Health
- Bilirubin Metabolism
Background:
- Significant hyperbilirubinemia (SHB) poses a risk for chronic auditory toxicity in newborns.
- Current markers like total serum bilirubin (TSB) are insufficient for identifying at-risk infants.
Purpose of the Study:
- To compare the efficacy of TSB, bilirubin albumin molar ratio (BAMR), and unbound bilirubin (UB) in predicting auditory toxicity in neonates with SHB.
Main Methods:
- Prospective longitudinal study in India involving infants ≥34 weeks gestational age with SHB.
- Comprehensive auditory evaluations (auditory brainstem response, tympanometry, otoacoustic emissions, audiometry) performed at 2-3 and 9-12 months.
- Audiologist blinded to infant's jaundice severity.
Main Results:
- Unbound bilirubin (UB) was significantly associated with auditory toxicity (OR 2.41, P=.001), outperforming TSB and BAMR.
- Area under the receiver operating characteristic curves showed UB (0.866) was superior to TSB (0.775) and BAMR (0.724) in predicting toxicity (P=.03).
Conclusions:
- Unconjugated hyperbilirubinemia, specifically when indexed by UB, is a more accurate predictor of chronic auditory toxicity in neonates with SHB than TSB or BAMR.
- UB measurement can aid in identifying infants requiring closer monitoring or intervention to prevent hearing loss.
Background And Objectives:
Significant hyperbilirubinemia (SHB) may cause chronic auditory toxicity (auditory neuropathy spectrum disorder and/or sensorineural hearing loss); however, total serum bilirubin (TSB) does not discriminate neonates at risk for auditory toxicity. Our objective was to compare TSB, bilirubin albumin molar ratio (BAMR), and unbound bilirubin (UB) for their association with chronic auditory toxicity in neonates with SHB (TSB ≥20 mg/dL or TSB that met criteria for exchange transfusion).
Methods:
Infants ≥34 weeks' gestational age (GA) with SHB during the first 2 postnatal weeks were eligible for a prospective longitudinal study in India. Comprehensive auditory evaluations were performed at 2 to 3 months of age by using auditory brainstem response, tympanometry, and an otoacoustic emission test and at 9 to 12 months of age by using audiometry. The evaluations were performed by an audiologist unaware of the degree of jaundice.
Results:
A total of 93 out of 100 infants (mean GA of 37.4 weeks; 55 boys, 38 girls) who were enrolled with SHB were evaluated for auditory toxicity. Of those, 12 infants (13%) had auditory toxicity. On regression analysis controlling for covariates, peak UB (but not peak TSB or peak BAMR), was associated with auditory toxicity (odds ratio 2.41; 95% confidence interval: 1.43-4.07; P = .001). There was significant difference in the area under the receiver operating characteristic curves between UB (0.866), TSB (0.775), and BAMR (0.724) for auditory toxicity (P = .03) after controlling for covariates.
Conclusions:
Unconjugated hyperbilirubinemia indexed by UB (but not TSB or BAMR) is associated with chronic auditory toxicity in infants ≥34 weeks' GA with SHB.
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