PEDIATRICS Vol. 72 No. 5 November 1983, pp. 658-664
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Auditory Nerve-Brainstem Evoked Responses in Hyperbilirubinemic Neonates

Max Perlman MB, MRCP, FRCP(C)1, Pinchas Fainmesser MD1, Haim Sohmer PhD1, Hanna Tamari MD1, Yohanan Wax PhD1, and Bella Pevsmer MSc1

1 From the Department of Pediatrics, Hadassah-Hebrew University Medical School; Department of Physiology, Hebrew University Medical School; and Department of Statistics, Hebrew University, Jerusalem

On the basis of the known predilection of the auditory brainstem pathway for bilirubin toxicity, we have examined auditory brainstem responses of neonates during the period of hyperbilirubinemia. The auditory brainstem responses of 24 infants with serum bilirubin values between 15 to 25 mg/dL were compared with the responses of 19 infants without hyperbilirubinemia, who had similar gestational and postnatal ages. Wave IV-V complex was absent in at least one recording of 10/24 jaundiced infants, whereas wave complex IV-V was consistently present in all of the 19 infants without hyperbilirubinemia (P <.001). Jaundiced infants also had prolonged brainstem transmission time (P <.01) which reflected increased latency at both lower and upper brainstem levels. The above changes were rapidly reversed in the majority of instances. Neonatal jaundice was associated with significant transient aberrations of auditory brainstem responses, suggestive of a transient brainstem encephalopathy. This evidence of bilirubin entry to the brain at conventionally acceptable serum concentrations raises questions about current concepts of the mechanism of transfer of bilirubin across the blood-brain barrier.

Key Words: hyperbilirubinemia • auditory evoked responses • encephalopathy

Submitted on December 3, 1982
Accepted on February 8, 1983




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