Auditory toxicity in late preterm and term neonates with severe jaundice.
Auditory toxicity in late preterm and term neonates with severe jaundice.
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DOI：
10.1111/dmcn.13284
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发表时间：
2017-03
影响因子：
3.8
通讯作者：
Agarwal A
中科院分区：
文献类型：
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作者：
Amin SB;Saluja S;Saili A;Laroia N;Orlando M;Wang H;Agarwal A
Ja可能导致听觉毒性（听神经病和听力损失）。然而，总血清胆红素（TSB）不能区分听力毒性风险的新生儿。我们比较了TSB、胆红素：白蛋白摩尔比（BAMR）和未结合胆红素与重度黄疸新生儿（TSB ≥342μmol/L，或符合换血标准）听觉毒性的关系。胎龄大于或等于34周且出生后前两周内出现重度黄疸的新生儿符合前瞻性队列研究的条件，除非他们有颅面畸形、染色体疾病、弓形体病、其他感染、风疹、巨细胞病毒和单纯疱疹病毒感染、手术或先天性耳聋家族史。100例新生儿中有28例（平均胎龄37.4周;男59例，女41例）有听觉毒性。在重度（TSB <427.5μmol/L）和极重度高胆红素血症（TSB ≥ 427.5 μ mol/L）新生儿中，未结合胆红素峰值与听觉毒性相关（p<0.05），而TSB和BAMR峰值与听觉毒性无关。在重度但非极重度高胆红素血症新生儿中，未结合胆红素的受试者工作特征曲线下面积（0.78）显著大于TSB（0.54）（p=0.03）。对于胎龄大于或等于34周的重度黄疸新生儿，未结合胆红素与听力毒性的相关性比TSB和/或BAMR更强。对于新生儿重度高胆红素血症，未结合胆红素是比TSB更好的预测因子。
Jaundice may cause auditory toxicity (auditory neuropathy and hearing loss). However, total serum bilirubin (TSB) does not discriminate neonates at risk for auditory toxicity. We compared TSB, bilirubin:albumin molar ratio (BAMR), and unbound bilirubin for their association with auditory toxicity in neonates with severe jaundice (TSB ≥342μmol/L, or that met exchange transfusion). Neonates greater or equal to 34 weeks’ gestational age with severe jaundice during the first two postnatal weeks were eligible for prospective cohort study, unless they had craniofacial malformations, chromosomal disorders, toxoplasmosis, other infections, rubella, cytomegalovirus, and herpes simplex infections, surgery, or family history of congenital deafness. Twenty-eight out of 100 neonates (mean gestational age 37.4wks; 59 males, 41 females) had auditory toxicity. Peak unbound bilirubin, but not peak TSB and BAMR, was associated with auditory toxicity (p<0.05) in neonates with severe (TSB <427.5μmol/L) and extreme hyperbilirubinemia (TSB ≥427.5μmol/L). Area under the receiver operating characteristic curve for unbound bilirubin (0.78) was significantly greater (p=0.03) than TSB (0.54) among neonates with severe but not extreme hyperbilirubinemia. Unbound bilirubin is more strongly associated with auditory toxicity than TSB and/or BAMR in greater or equal to 34 weeks’ gestational age neonates with severe jaundice. Unbound bilirubin is a better predictor than TSB in neonates with severe hyperbilirubinemia.