All issues > Volume 33(9); 1990

Original Article

J Korean Pediatr Soc. 1990;33(9):1216-1222. Published online September 30, 1990.

Changes in Auditory Brainstem Reponses (ABR) in Severe Hyperbilirubinemic Neonates with Transient Bilirubin Encephalopathy.

Chong Woo Bae¹, Sa Jun Chung¹, Chang Il Ahn¹

¹Department of Pediatrics, College of Medicine, Kyung Hee University, Seoul, Korea

Received: May 19, 1990;  Accepted: July 4, 1990.

Abstract

Many authors have reported alterations in the ABR in severe hyperbilirubinemia and ABR is an effective non-invasive method of assessing the functional status of the auditory nerve and brainstem sensory pathway in the management of neonatal hyperbilirubinemia. Perlman et al reported that jaundice in the early neonatal period is associated with significant transient aberration of ABR, suggestive of a transient bilirubin encephalopathy (TBE). And they hypothesized between the time bilirubin enters the CNS and the time that kernicterus occurs. They called that status as TBE, which was immediate effects of bilirubin on CNS function and complete reversible and that it is clinically acceptable for bilirubin to be there. TBE is detected by means of neurophysiolosic probes such as ABR. This study attempts to evaluate the frequency of TBE in severe hyperbilirubinemic neonates who were treated by exchange transfusion (ET) and to evaluate the clinical utility of ABR. Among the total 34 neonates who were treated by ET, seven cases of TBE were appeared (20.6%). All of seven cases of TBE were under the 7 days of age, and 2 cases were pre-term and 5 cases were term. According to bilirubin concentration, 2 cases were 20 〜 24 mg/dl, 4 cases were higher than 25 mg/dl. Among 7 cases, of TBE, abnormal ABR findings were as follows: wave V loss were 6 cases, prolonged I-III or IPL and low amplitude were 2 cases respectively, and wave III lose was 1 case. Total 7 cases of TBE revealed the initial abnormal ABR findings to normal level: 6 cases were after 24 hours ET and 1 cases was after 48 hours ET. And they did not showed the abnormal neurologic examination on regular follow up check. So, we can suggest the following conclusions: we can apply the term of TBE in neonatal field especially hyperbilirubinemia of newborn, recordings and findings of ABR are new one part of criteria for ET and ABR is one of useful diagnostic tool for detecting of bilirubin induced neurotox- icity.

Keywords :Hyperbilirubinemia of newborn, Transient bilirubin encephalopathy, Auditory brainstem response