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PPT Journal Reading THT-KL (Salmiyanti 200611202).pptx
- 1. Salmiyanti, S.Ked 2006112042 Preceptor: Dr. dr. Indra Zachreini, Sp.THT-KL(K), FISCM Hyperbilirubinemia and Follow- up Auditory Brainstem Responses in Preterm Infants (Hiperbilirubinemia dan Tindak Lanjut Auditori Respons Batang Otak pada Bayi Prematur) Journal Reading
- 3. Hyperbilirubinemia in infants is the major leading cause of neonatal intensive care unit (NICU) treatment and is known to be an important risk factor for neonatal hearing loss. Up to 80% of preterm infants in NICU have a hyperbilirubinemia, which often present as jaundice due to bilirubin deposition. Bilirubin has been reported to damage cochlear nuclei and accumulation bilirubin in the auditory pathway, the mechanism of bilirubin-induced hearing loss has not been clearly establish. INTRODUCTION
- 4. The purpose of this study is : to evaluate the effect of hyperbilirubinemia on hearing threshold and auditory pathway in preterm infants by serial ABR. To evaluated the usefulness of the UCB concentration as compared with TSB in predicting bilirubin-induced hearing loss in preterm infants.
- 5. All preterm infants, under 37 weeks gestational age, who were admitted to the NICU of the Severance Hospital for the treatment of hyperbilirubinemia from January 2013 to December 2017 were eligible for the study. Exclusion criteria included chromosomal abnormalities, TORCH (toxoplasmosis, rubella, cytomegalovirus and herpes simplex) infections, and cases where baseline testing could not be completed. So, the selected study population were 70 infants. Patients
- 6. All NICU children participate a two-stage AABR examination. The result of AABR was assumes an infant as passing the test when both ears were reacted to 35 dB nHL click sound stimulus. When the first test failed to pass, a retest was performed at intervals of 1 day or more. Infants who did not pass the AABR examination were referred to department of ENT for diagnostic ABR, considered as decision tools of hearing loss. The result of ABR was defined abnormal when the infants hearing threshold exceed more than 40 dB nHL in at least one ear. Those infants with hearing threshold 40 dB nHL at diagnostic ABR examination, performed follow-up ABR within 3 to 6 months. Auditory brain respons
- 7. Bilirubin concentration was examined in the first 5 postnatal days or when clinically indicated. The UCB concentration was calculated by subtracting the direct bilirubin from the TSB concentration. Bilirubin measurement
- 8. statistical analysis All statistical analyses were performed using SPSS ver. 12.0 (SPSS Inc., Chicago, IL, USA). The difference in parameters between two groups was tested using independent t-test. Spearman correlation analysis was used to identify linear associations between two variables. The sensitivity and specificity of bilirubin level as predictors of hearing loss were evaluated using receiver operating characteristic (ROC) curves. All data are presented as means and standard deviations. A P-value <0.05 was considered to reflect statistically significance
- 9. RESULT
- 10. RESULT Table 1. Clinical characteristics, risk factors of hyperbilirubinemic preterm infants <37 weeksof gestational age stratified by diagnostic ABR thresholds Table 2. Comparison of bilirubin concentration between ABR 35 dB nHL and 40 dB nHL groups
- 11. RESULT correlation between bilirubin concentration and diagnostic auditory brainstem response (ABR) threshold. (A) Relationship between unconjugated bilirubin (UCB) and ABR threshold. (B) Relationship between total serum bilirubin (TSB) and ABR threshold.
- 12. Receiver operating characteristic curves predicting the risk of hearing loss according to bilirubin level. UCB, unconjugated bilirubin; TSB, total serum bilirubin; AUC, area under the curve; SE, standard error; sig, significance; CI, confidence interval. a)Under the nonparametric assumption. b)Null hypothesis: true area, 0.5.
- 13. Table 3. Comparison of follow-up hearing results and bilirubin concentration between complete recovered and non-recovered group
- 14. PRINCIPLES OF HEARING LOSS PREVENTION In this study, we found that UCB concentration were significantly increased in infants with abnormal findings in diagnostic ABR (40 dB nHL) than in TSB concentration. In addition, direct correlation was found between the UCB concentration and the hearing threshold confirmed by ABR. Moreover, a significant relationship was founded between UCB level and hearing loss, which defined threshold 40 nHL in diagnostic ABR. In ROC curves, UCB level above 13 mg/dL provide best sensitivity and specificity These results of our study and several others suggest that UCB in preterm infants related with hyperbilirubinemia is a better predictor of bilirubin- induced hearing loss as indicated by diagnostic ABR This retrospective study showed hearing results of the preterm infants of hyperbilirubinemia by serial ARB and relationship between hearing status and UCB compared with TSB.
- 15. Bilirubin is a kind of neurotoxic substance that changes in energy metabolism, alteration in membrane function, decreased membrane potential, alteration in enzyme function, and inhibition of protein and DNA synthesis. Bilirubin has been reported damage to cochlear nuclei and auditory pathway through cochlear nerve, and the cochlear itself is often normal. Thus, hyperbilirubinemia often causes ANSD, which defined by abnormal ABR finding in the presence of normal optoacoustic emissions (OAE). ABR is most commonly used modality to investigate bilirubin-induced neuronal damage in neonates and preterm infants, which as a direct, noninvasive assessment. Hearing loss caused by hyperbilirubinemia is found to be reversible but follow-up ABR test can also show permanent hearing loss, therefore it is necessary to accurately diagnose the bilirubin- induced hearing loss by sequential ABR test.
- 16. This is the first study to report on evaluation of relationship between hearing status and bilirubin concentration through the AABR, diagnostic ABR to follow up ABR. Our study demonstrates that UCB concentration is a better predictor of bilirubin-induced hearing loss than TSB in preterm infants as evaluated by serial ABR. Serial ABR testing can be a useful, noninvasive methods to evaluate early reversible bilirubin- induced hearing loss in preterm infants.
- 17. THANK YOU!