Relationship of Serum Bilirubin Levels to Ototoxicity and Deafness in High-Risk Low-Birth-Weight Infants

PEDIATRICS ◽  
1985 ◽  
Vol 76 (3) ◽  
pp. 351-354
Author(s):  
L. S. de Vries ◽  
S. Lary ◽  
L. M.S. Dubowitz
Keyword(s):  
Birth Weight ◽  
High Risk ◽  
Preterm Infants ◽  
Bilirubin Level ◽  
Serum Bilirubin ◽  
Sensorineural Deafness ◽  
Serum Bilirubin Level ◽  
Low Birth Weight Infants ◽  
High Risk Infants ◽  
L 14

During a 4-year period, 12 premature infants, all less than 34 weeks of gestation and all with a bilirubin level above 240 µmol/L (14 mg/dL) were determined to have bilateral sensorineural deafness. In order to investigate how far the hyperbilirubinemia or any associated factor might have been a causative factor, all infants of 34 weeks of gestation or less who had a serum bilirubin level above 240 µmol/L were investigated. For a period of 4 years, 99 infants meeting these criteria were classified as high risk or low risk on the basis of perinatal risk factors. Eight of the 22 high-risk infants with birth weight less than 1,500 g, but only two of 43 high-risk infants with birth weight greater than 1,500 g were deaf (P < .05). The deaf infants were also matched with infants of normal hearing who had similar bilirubin levels and the same number of adverse perinatal factors. The mean duration of hyperbilirubinemia was significantly longer in the deaf infants (P < .02), and they appeared to have a greater number of acidotic episodes while they were hyperbilirubinemic. These findings suggest that in healthy preterm infants with birth weight greater than 1,500 g, high bilirubin levels carry little risk, whereas a serum bilirubin level greater than 240 µmol/L in highrisk preterm infants with birth weight of 1,500 g or less is associated with a high risk of deafness.

Relationship Between Bilirubin and Hearing Loss

PEDIATRICS ◽  
1986 ◽  
Vol 77 (6) ◽  
pp. 929-929
Author(s):  
KEITH J. GALLAHER ◽  
M. JEFFREY MAISELS
Keyword(s):  
Hearing Loss ◽  
Birth Weight ◽  
High Risk ◽  
Low Birth Weight ◽  
Serum Bilirubin ◽  
Sensorineural Deafness ◽  
Potential Influence ◽  
Low Birth Weight Infants ◽  
Lower Serum ◽  
Similar Association

To the Editor.— De Vries et al1 describe an interesting association between serum bilirubin levels > 14 mg/dL and sensorineural deafness in low birth weight infants. A similar association (in infants who were exposed to lower serum bilirubin levels) was reported by Bergman et al.2 These results are important because of their potential influence on how we treat these infants, yet they raise certain questions. The authors classified infants as "high risk" or "low risk" based on the presence of certain "adverse factors," but they do not tell us about the distribution of these factors in the study patients.

A Novel Approach to Phototherapy Initiation in Preterm Infants

2020 ◽  
Vol 1 (1) ◽  
pp. 1-3
Author(s):  
Shabih Manzar
Keyword(s):  
Body Weight ◽  
Birth Weight ◽  
Preterm Infants ◽  
Bilirubin Level ◽  
Serum Bilirubin ◽  
Serum Bilirubin Level ◽  
Therapeutic Interventions ◽  
Novel Approach

Therapeutic interventions in preterm infants are determined based on birth weight. Phototherapy (PTx) is the treatment for hyperbilirubinemia, started based on serum bilirubin level. However, weight-based guidelines for PTx in preterm infants are lacking. We present a simple way of calculating the bilirubin to initiate PTx. A percentage body weight, ranging from 0.5%-1%, is used to calculate bilirubin.

Double Versus Single Phototherapy in Low Birth Weight Newborns

PEDIATRICS ◽  
1992 ◽  
Vol 90 (5) ◽  
pp. 674-677
Author(s):  
Paul C. Holtrop ◽  
Kathleen Ruedisueli ◽  
M. Jeffrey Maisels
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Bilirubin Level ◽  
Serum Bilirubin ◽  
Elevated Serum ◽  
Threshold Level ◽  
Serum Bilirubin Level ◽  
Total Serum ◽  
The Difference ◽  
To Receive

Conventional phototherapy systems that simultaneously irradiate the front and the back of the baby lower the serum bilirubin level more rapidly than one-sided systems, but they are impractical. Fiberoptic phototherapy makes it easy to administer conventional phototherapy from above while the infant lies on a fiberoptic phototherapy blanket. Newborns with birth weights less than 2500 g were randomly assigned to receive either single (n = 37) or double (n = 33) phototherapy. The groups were similar in clinical and laboratory characteristics. After 18 hours of therapy the serum bilirubin concentration declined by 31 ± 11% in the double and 16 ± 15% in the single phototherapy group (2.9 ± 1.1 vs 1.6 ± 1.4 mg/dL), and the difference in the total serum bilirubin levels after 18 hours of therapy was significant (double phototherapy group 7.1 ± 2.7 mg/dL vs single phototherapy group 8.2 ± 2.6 mg/dL). After 18 hours of treatment the serum bilirubin level was less than the phototherapy threshold level in 26 of 37 single phototherapy patients vs 32 of 33 double phototherapy patients. Double phototherapy was well tolerated. It is concluded that this type of double phototherapy is more effective than single phototherapy in low birth weight newborns. Double phototherapy may be useful when it is necessary to reduce an elevated serum bilirubin level as rapidly as possible or when the bilirubin level is rising with single phototherapy.

scholarly journals Phototherapy in different stages of birth weight for the treatment of neonatal hyperbilirubinaemia

1970 ◽  
Vol 18 ◽  
pp. 116-120
Author(s):  
T Paul ◽  
R Parial ◽  
MA Hasem ◽  
S Mojumder ◽  
MM Islam ◽  
...  
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Bilirubin Level ◽  
Neonatal Sepsis ◽  
Serum Bilirubin ◽  
Very Low Birth Weight ◽  
Perinatal Asphyxia ◽  
Serum Bilirubin Level ◽  
Decline Rate ◽  
Group 1

Context: The goal of phototherapy is to lower the concentration of circulating bilirubin or keep it from increasing in the treatment of neonatal unconjugated hyperbilirubinaemia. As phototherapy decrease billirubin level of infants, it is important to fix the dose of phototherapy.   Objectives: The aim of the study was to compare the effectiveness of double phototherapy versus conventional single phototherapy in the treatment of neonatal unconjugated hyperbilirubinaemia.   Materials and Methods: For this purpose 50 term and preterm newborns were enrolled. They were divided into 2 groups, 38 newborns were taken in group 1 and 12 newborn were taken in group 2. The babies who got conventional single phototherapy were taken in group 1. Each group was again divided into 3 subgroups according to their birth weight Normal Birth Weight (NBW), = Low Birth Weight (LBW) and Very Low Birth Weight (VLBW).   Results: The serum bilirubin level of term babies were found 17.32 ± 4.08 mg/dl and in preterm babies were found 13.17 ± 1.49 mg/dl. Neonatal hyperbilirubinaemia in enrolled babies were due to physiologic jaundice (38%), neonatal sepsis (50%) and perinatal asphyxia (12%). The serum bilirubin level in physiological jaundice was found 18.47 ± 5.38 mg/dl, in neonatal sepsis was found 14.90 ± 1.85 mg/dl and in perenatal asphyxia was found 14.10 ± 1.47 mg / dl. Decline rate of serum bilirubin per day was found 4.58 ± 2.43 mg / dl in NBW babies with the use of conventional single phototherapy compared to 6.27 ± 2.26 mg / dl with the use of conventional double phototherapy. In LBW babies decline rate of serum bilirubin per day was found 2.07 ± 0.84 mg / dl with the use of conventional single phototherapy but 4.70 ± 2.08 mg / dl with the use of conventional double phototherapy. In VLBW babies, decline rate of serum bilirubin per day was found 2.24 ± 1.10 mg / dl with the use of conventional single phototherapy. Any VLBW babies which were given conventional double phototherapy were not found. Conclusion: From this study it can be concluded that double phototherapy is more effective than conventional single phototherapy in the treatment of neonatal hyperbilirubinaemia in both groups of neonates; however the rate of fall of bilirubin was higher in NBW subgroups. Keywords: Phototherapy; hyperbilirubinaemia; preterm; term. DOI: http://dx.doi.org/10.3329/jbs.v18i0.8786 JBS 2010; 18(0): 116-120

scholarly journals Incidence of neonatal hyperbilirubinemia in low, intermediate-low, and intermediate-high risk group infants

2016 ◽  
Vol 50 (6) ◽  
pp. 351
Author(s):  
Ahmed Widiasta ◽  
Lelani Reniarti ◽  
Abdurachman Sukadi
Keyword(s):  
High Risk ◽  
Bilirubin Level ◽  
Serum Bilirubin ◽  
Risk Group ◽  
Serum Bilirubin Level ◽  
High Risk Group ◽  
Low Risk ◽  
Neonatal Hyperbilirubinemia ◽  
Total Serum ◽  
Total Serum Bilirubin Level

Background Neonatal hyperbilirubinemia is commonly found in newborns. Assessment of the risk of hyperbilirubinemia and information on the average time of the occurrence of hyperbilirubinemia are important to prevent the development of severe hyperbilirubinemia.Objective To find out the incidence of and the time of the development of hyperbilirubinemia in healthy-term newborns.Method A cohort prospective study was done on healthy-term newborns born at Hasan Sadikin Hospital between November and December 2009. Subjects were divided into 4 groups of risk at discharged, based on Bhutani nonnogram. A serial bilirubin level measurement were perfonned within 6 days.Resu l ts One of 14 newborns at low risk group developed hyperbilirubinemia but did not need phototherapy. Six of 14 newborns at intermediate-low risk group developed hyperbilirubinemia, 2 of them needed phototherapy with total serum bilirubin level of 14.7 mg/dL at 57 hours and 19.8 mg/dL at111 hours. Nine of 15 newborns of intennediate-high risk group developed hyperbilirubinemia, 1 of them needed phototherapy with total serum bilirubin level of 16.6 mg/dL at 76 hours. There was no newborn cathegorized as high risk group in this study. The median time the occurrence of hyperbilirubinemia in intennediate-low and intennediate-high risk group was 140 hours and 82 hours, respectively. There was no significant difference in survival curve between intennediate-high and intennediate-low risk groups (95% CI 108.1 to 1 2 5.4).Conclusion The incidence of hyperbilirubinemia was not different between intennediate-low and intermediate-high risk babies.

scholarly journals Hyperbilirubinemia in Preterm Infants Admitted to Neonatal Intensive Care Units in Ethiopia

2020 ◽  
Vol 7 ◽  
pp. 2333794X2098580
Author(s):  
Sara Aynalem ◽  
Mahlet Abayneh ◽  
Gesit Metaferia ◽  
Abayneh G. Demissie ◽  
Netsanet Workneh Gidi ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Preterm Infants ◽  
Bilirubin Level ◽  
Serum Bilirubin ◽  
Serum Bilirubin Level ◽  
Total Serum ◽  
P Value ◽  
Abo Incompatibility ◽  
Preterm Babies

Background. Hyperbilirubinemia is prevalent and protracted in preterm infants. This study assessed the pattern of hyperbilirubinemia in preterm infants in Ethiopia. Methods. This study was part of multi-centered prospective, cross-sectional, observational study that determined causes of death among preterm infants. Jaundice was first identified based on clinical visual assessment. Venous blood was then sent for total and direct serum bilirubin level measurements. For this study, a total serum bilirubin level ≥5 mg/dL was taken as the cutoff point to diagnose hyperbilirubinemia. Based on the bilirubin level and clinical findings, the final diagnoses of hyperbilirubinemia and associated complications were made by the physician. Result. A total of 4919 preterm infants were enrolled into the overall study, and 3852 were admitted to one of the study’s newborn intensive care units. Of these, 1779 (46.2%) infants were diagnosed with hyperbilirubinemia. Ten of these (0.6%) developed acute bilirubin encephalopathy. The prevalence of hyperbilirubinemia was 66.7% among the infants who were less than 28 weeks of gestation who survived. Rh incompatibility ( P = .002), ABO incompatibility ( P = .0001), and sepsis ( P = .0001) were significantly associated with hyperbilirubinemia. Perinatal asphyxia ( P-value = 0.0001) was negatively associated with hyperbilirubinemia. Conclusion. The prevalence of hyperbilirubinemia in preterm babies admitted to neonatal care units in Ethiopia was high. The major risk factors associated with hyperbilirubinemia in preterm babies in this study were found to be ABO incompatibility, sepsis, and Rh isoimmunization.

FRESH APPROACHES TO PROSPECTIVE STUDIES OF HIGH RISK INFANTS

PEDIATRICS ◽  
1970 ◽  
Vol 45 (1) ◽  
pp. 7-8
Author(s):  
C. M. Drillien
Keyword(s):  
Birth Weight ◽  
High Risk ◽  
Low Birth Weight ◽  
Prospective Studies ◽  
Low Birth Weight Infants ◽  
Term Study ◽  
New Techniques ◽  
Long Term Study ◽  
High Risk Infants

The widespread development of special care and premature units is providing an added stimulus to neonatologists and their colleagues to embark on prospective studies of the later development of high risk infants. Indeed, it is only thus that one can judge the efficacy of new techniques in postnatal care made possible by concentrating numbers of such infants in special units. Since low birth weight is associated with a higher incidence of handicap than any other commonly occurring perinatal complication, low birth weight infants have been and continue to be the most popular subjects for long-term study. The reports by Eaves,et al.1 and Parmelee and Schulte in this issue are current examples.

Executive Summary

PEDIATRICS ◽  
1985 ◽  
Vol 75 (2) ◽  
pp. 385-386
Keyword(s):  
Birth Weight ◽  
Serum Bilirubin ◽  
Enterohepatic Circulation ◽  
Light Therapy ◽  
Light Treatment ◽  
Serum Bilirubin Level ◽  
Controlled Study ◽  
Low Birth Weight Infants ◽  
Bilirubin Concentration ◽  
Executive Summary

A randomized, controlled study of phototherapy for neonatal hyperbilirubinemia was supported by the National Institute of Child Health and Human Development between 1974 to 1976. The study included 672 infants receiving phototherapy and 667 control infants. Phototherapy was effective in preventing hyperbilirubinemia in low-birth-weight infants (<2,000 g) who were placed under daylight fluorescent lights at 24 ± 12 hours of life for 96 hours. In this weight group, the number of exchange transfusions that were required due to hyperbilirubinemia was significantly lower in infants receiving phototherapy (4.1%) than in control infants (24.4%, P < .001). This was true even in infants with hemolysis and may be related to the fact that light treatment was initiated well before the development of hyperbilirubinemia. Phototherapy was effective in controlling hyperbilirubinemia in infants of birth weight 2,000 to 2,499 g when initiated after serum bilirubin concentration had risen above 10 mg/dL (mean 12.3 ± 1.9 mg/dL), as well as in infants with birth weight greater than 2,500 g whose serum bilirubin level had risen above 13 mg/dL (mean 15.7 ± 2.5 mg/dL) and in whom there was no hemolytic disorder. Light therapy instituted at these high levels of serum bilirubin did not effectively control hyperbilirubinemia in these two groups if hemolysis was present. Black infants responded to phototherapy as well as the nonblack infants. Phototherapy was most effective in the first 24 to 48 hours of its use. The pattern of declining efficacy after 48 hours is consistent with the thesis that unstable bilirubin isomers (photobilirubin) formed during the light treatment revert to natural bilirubin in the intestine following hepatic excretion and are reabsorbed via the enterohepatic circulation and contribute again to the bilirubin load to be cleared by the liver.

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