Hyperbilirubinemia impact on newborn hearing: a literature review

Teixeira, Marcela Hammes; Borges, Viviann Magalhães Silva; Riesgo, Rudimar dos Santos; Sleifer, Pricila

doi:10.1590/1806-9282.66.7.1002

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REVIEW ARTICLE • Rev. Assoc. Med. Bras. 66 (7) • July 2020 • https://doi.org/10.1590/1806-9282.66.7.1002 linkcopy

Hyperbilirubinemia impact on newborn hearing: a literature review

Authorship SCIMAGO INSTITUTIONS RANKINGS

The increase in bilirubin levels in newborns can cause toxic effects on the auditory system, which can lead to hearing loss. This review aimed to verify the impact of hyperbilirubinemia in the hearing of newborns, relating audiological findings to serum levels of bilirubin. A literature review was conducted during October 2017, using the terms “hyperbilirubinemia”, “jaundice”, “infant”, “newborn” and “hearing loss”, on databases CAPES journals, MEDLINE and BIREME (SciELO, BBO). 827 studies were identified and 59 were selected for full-text reading, resulting in the selection of seven articles that met the inclusion criteria and were considered relevant to the sample of this study. All the reviewed studies performed brainstem auditory evoked potential as the main test for audiological evaluation. Changes in the audiological findings of neonates with hyperbilirubinemia were observed in all studies. There was no consensus on the serum bilirubin levels that may cause auditory changes; however, the relationship between hearing disorders and blood levels of bilirubin was positive. We identify the need to establish reference values for bilirubin levels considered critical for the occurrence of hearing disorders as well as the audiological follow-up of neonates with hyperbilirubinemia.

Hyperbilirubinemia; Infant, newborn; Jaundice; Hearing loss

Author and year	Study design	Population studied and bilirubin levels	Exams Carried out	Time of the auditory evaluation	Objective of the study	Audiological results
Okhravi et al.³ (2015)	Case- control	Full term and pre-term NB with serum bilirubin ≥18 mg/dL.	ABR	At hospital discharge.	Compare the ABR results of NB with and without hyperbilirubinemia.	Increase of absolute waves I, III, and V latencies and of interpeak intervals (I-V, I-III and III-V) at hospital discharge.
Chapchap et al.¹⁸ (2006)	Case- control	Full-term NB with hyperbilirubinemia GI: severe physiological jaundice. GII: hemolytic jaundice.	ABR	On the day of the highest peak of serum bilirubin.	Evaluate the conduction of stimulus in the auditory pathway, comparing the responses between the two groups evaluated.	Increase of the absolute latency of wave I and of interpeak III-V interval
Martiñón et al.¹⁶ (2000)	Case- control	Full-term NB with different levels of bilirubin GI: 12 -20.9 mg/dL GII: 21 -24.9 mg/dL GIII: 25 -27.9 mg/dL GIV: ≥28 g/dL	EOA and ABR	After the treatment (phototherapy and/or exchange transfusion)	Evaluate and compare the responses obtained from the four groups studied.	Adequate absolute latency of waves I and V, and reduction of the absolute latency and amplitude of wave III.
Agrawal et al.¹³ (1998)	Case- control	Full-term NB with different levels of bilirubin GA: 15 -20 mg/dL GB: 21 -25 mg/dL GC: >25 mg/dL	ABR	Before the treatment (phototherapy/exchange transfusion); when bilirubin levels <12 mg/dL; 14 weeks; 1 year.	Compare the findings obtained on the ABR between the groups, as well as before and after the treatment.	Increase of absolute latency of waves I, III, and V and of interpeak intervals (I-III and III-V). Reduction of these after the treatment.
Bhandari et al.¹⁴ (1993)	Longitudinal	Full-term NB with plasma bilirubin ≥15mg/dL	ABR	24h after the hyperbilirubinemia diagnosis and after the treatment, when bilirubin ≤10 mg/dL	Study the effect of hyperbilirubinemia in ABR and analyze the responses obtained on the ABR after the treatment.	Increase of absolute latencies of waves I, III, and V and of interpeak intervals (I-V, I-III, and III-V) before the treatment and their reduction after the treatment.
Tan et al.¹⁷ (1992)	Case- control	Full-term NB with a diagnosis of hyperbilirubinemia.	ABR	Before phototherapy; 24h after phototherapy; after phototherapy; one day after the end of phototherapy.	Evaluate how the reduction of bilirubin levels from phototherapy affects the ABR.	Increase of the absolute latency of wave V and of interpeak I-V and III-V. After phototherapy, the values were close to normal.
Gupta et al.¹⁵ (1990)	Case- control	Full-term NB with serum bilirubin ≥20mg/dL.	ABR	At hospital discharge. RN who failed this test were reassessed at 3 and 6m.	Evaluate abnormalities in the ABR in newborns with hyperbilirubinemia who underwent exchange transfusion compared to NB without jaundice.	Increase of the absolute latency of waves III and V and of the interpeak intervals I-V. The latencies decreased at the retest after 3 months.

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[TFN1] NB: newborn; G: group, ABR: Evoked auditory brainstem response; OAE: distortion-product otoacoustic emissions; mg/dL: milligrams per deciliter