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Vigintiphobia, unbound bilirubin, and auditory brainstem responses
Pediatrics
|January 1, 1994
Summary
Serum unbound bilirubin concentrations (UBCs) better predict auditory brainstem response (ABR) abnormalities in newborns with jaundice than total bilirubin. Measuring UBCs may help assess the risk of bilirubin encephalopathy in term infants.
Area of Science:
- Neonatal Medicine
- Neuroscience
- Biochemistry
Background:
- Nonhemolytic hyperbilirubinemia management in term newborns remains controversial.
- Auditory brainstem responses (ABRs) are used to assess auditory pathway function.
- Serum unbound bilirubin concentrations (UBCs) are proposed as a marker for bilirubin neurotoxicity.
Purpose of the Study:
- To evaluate the clinical utility of serum UBCs in managing hyperbilirubinemia in term newborns.
- To compare UBC concentrations with abnormal ABR findings.
Main Methods:
- 37 term newborns with hyperbilirubinemia (total bilirubin [TB] ≥ 20 mg/dL) underwent ABR and serum UBC measurements before treatment.
- Newborns were categorized into three groups based on ABR findings: normal, prolonged wave I latency, or prolonged interpeak latency/poor amplitude.
- Blood incompatibilities were noted in 8 newborns.
Main Results:
- Abnormal ABR findings (Groups B and C) were associated with significantly higher peak UBCs compared to normal ABR (Group A).
- Multiple logistic regression analysis indicated that UBC levels (at 1.0 µg/dL) were more strongly associated with abnormal ABRs than total bilirubin concentrations (at 23 mg/dL).
- The odds ratio for abnormal ABR was 16.6 for UBC versus 4.2 for TBC.
Conclusions:
- Serum UBC measurement may aid in assessing the risk of bilirubin encephalopathy in term newborns.
- UBC appears to be a more sensitive indicator of potential neurotoxicity than total bilirubin levels.