Published online May 1, 2008
PEDIATRICS Vol. 121 No. 5 May 2008, pp. 976-978 (doi:10.1542/peds.2007-2297)
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrowRequest Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Ahlfors, C. E.
Right arrow Articles by Parker, A. E.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Ahlfors, C. E.
Right arrow Articles by Parker, A. E.
Related Collections
Right arrow Premature & Newborn
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Digg   Add to Facebook   Add to Reddit   Add to Technorati   Add to Twitter  
What's this?

ARTICLE

Unbound Bilirubin Concentration is Associated With Abnormal Automated Auditory Brainstem Response for Jaundiced Newborns

Charles E. Ahlfors, MD and Anne E. Parker, RN, NNP

Department of Pediatrics, Division of Neonatology, California Pacific Medical Center, San Francisco, California

OBJECTIVE. This study was conducted to determine whether incidental jaundice affects automated auditory brainstem response results.

METHODS. We reviewed the medical charts of jaundiced newborns of ≥34 weeks of gestation who underwent automated auditory brainstem response testing within 4 hours of plasma total bilirubin concentration and unbound bilirubin concentration measurements. We tested the hypothesis that the likelihood of abnormal automated auditory brainstem response results would increase as total bilirubin and unbound bilirubin concentrations increased.

RESULTS. Forty-four infants with proximate total bilirubin concentration, unbound bilirubin concentration, and automated auditory brainstem response measurements were identified, and 4 (9%) had bilateral refer automated auditory brainstem response results. The mean total bilirubin concentration of 21.4 mg/dL (SD: 4.0 mg/dL; range: 14.4–29.5 mg/dL) for the 40 infants with bilateral pass automated auditory brainstem response results was not significantly different from that of 23.0 mg/dL (range: 14.9–33.1 mg/dL) for the 4 infants with bilateral refer automated auditory brainstem response results. However, the mean unbound bilirubin concentration of 1.32 µg/dL (range: 0.22–2.99 µg/dL) for the 40 infants with bilateral pass results was significantly lower than the mean of 2.62 µg/dL (range: 0.88–4.41 µg/dL) for the 4 infants with bilateral refer results. Logistic regression showed that increasing unbound bilirubin concentrations but not increasing total bilirubin concentrations were associated with of bilateral refer automated auditory brainstem response results.

CONCLUSIONS. The probability of bilateral refer automated auditory brainstem response results increases significantly with increasing unbound bilirubin concentrations but not with increasing total bilirubin concentrations. Because unbound bilirubin concentrations are also more closely correlated with bilirubin neurotoxicity than are total bilirubin concentrations, bilateral refer automated auditory brainstem response results for jaundiced newborns may indicate increased risk of bilirubin neurotoxicity, in addition to the possibility of congenital deafness.

Key Words: newborn jaundice • hyperbilirubinemia • unbound bilirubin • peroxidase test • free bilirubin • automated auditory brainstem response • hearing screening

Abbreviations: AABR—automated auditory brainstem response • TBC—total bilirubin concentration

Accepted Sep 17, 2007.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Facebook Facebook   Add to Reddit Reddit   Add to Technorati Technorati   Add to Twitter Twitter    What's this?


This article has been cited by other articles:


Home page
 Clin. Chem.Home page
C. E. Ahlfors, R. P. Wennberg, J. D. Ostrow, and C. Tiribelli
Unbound (Free) Bilirubin: Improving the Paradigm for Evaluating Neonatal Jaundice
Clin. Chem., July 1, 2009; 55(7): 1288 - 1299.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
A. Okumura, H. Kidokoro, H. Shoji, T. Nakazawa, M. Mimaki, K. Fujii, H. Oba, and T. Shimizu
Kernicterus in Preterm Infants
Pediatrics, June 1, 2009; 123(6): e1052 - e1058.
[Abstract] [Full Text] [PDF]