Magnetic resonance spectroscopy and auditory brain-stem response audiometry as predictors of bilirubin-induced neurologic dysfunction in full-term jaundiced neonates

• Published in: European journal of pediatrics Vol. 183; no. 2; pp. 727 - 738
• Main Authors: Zidan, Lamiaa Khaled, Rowisha, Mohamed Ahmed, Nassar, Mohammed Abd Ellatif, Elshafey, Rasha Ahmed, El Mahallawi, Trandil Hassan, Elmahdy, Heba Saied
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.02.2024; Springer Nature B.V
• Subjects: Audiometry; Babies; Bilirubin; Brain; Brain research; Differential diagnosis; Encephalopathy; Evoked Potentials, Auditory, Brain Stem - physiology; Gestational age; Hearing loss; Humans; Hyperbilirubinemia; Hyperbilirubinemia, Neonatal - complications; Hyperbilirubinemia, Neonatal - diagnosis; Infant, Newborn; Jaundice; Kernicterus - diagnosis; Kernicterus - etiology; Light therapy; Magnetic Resonance Spectroscopy; Medicine; Medicine & Public Health; Neonates; Newborn babies; Pediatrics; Phototherapy; Prospective Studies; Spectrum analysis; Bilirubin encephalopathy; ABR; BIND; Neonatal hyperbilirubinemia; MRS
• ISSN: 1432-1076; 0340-6199; 1432-1076
• DOI: 10.1007/s00431-023-05246-z

The purpose of this research was to define the functions of MRS and ABR as predictors of bilirubin-induced neurologic dysfunction (BIND) in full-term neonates who required intervention (phototherapy and/or exchange transfusion ). This prospective cohort study was done at the NICU of Tanta University Hospitals over a 2-year duration. Fifty-six full-term neonates with pathological unconjugated hyperbilirubinemia were divided according to MRS and ABR findings into 2 groups: group (1) included 26 cases with mild acute bilirubin encephalopathy (BIND-M score 1–4). Group (2) included 30 cases with neonatal hyperbilirubinemia only. In addition, 20 healthy neonates with similar ages were employed as the controls. When compared to group 2 and the control group, group 1’s peak-area ratios of NAA/Cr and NAA/Cho were found to be significantly reduced ( P  < 0.05). As compared to group 2 and the control group, group 1’s Lac/Cr ratio was significantly greater ( P  < 0.05), but the differences were not significant for group 2 when compared to the control group. Waves III and V peak latencies, I–III, and I–V interpeak intervals were significantly prolonged in group 1 in comparison to group 2 and controls ( P  < 0.05) with no significant difference between group 2 and control group.     Conclusion : When the symptoms of ABE are mild and MRI does not show any evident abnormalities, MRS and ABR are helpful in differentiating individuals with ABE from patients with neonatal hyperbilirubinemia.     Trial registration :  ClinicalTrials.gov , Identifier: NCT06018012. What is Known: • MRS can be used as a diagnostic and prognostic tool for the differential diagnosis of patients with acute bilirubin encephalopathy, from patients with neonatal hyperbilirubinemia What is New: • ABR is a useful diagnostic and prognostic tool in the care and management of neonates with significantly raised bilirubin. It can be used as early predictor of acute bilirubin encephalopathy in the earliest stage of auditory damage caused by bilirubin.