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https://codas.org.br/article/doi/10.1590/2317-1782/20232022273pt
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Original Article

Como a hiperbilirrubinemia deve ser considerada na definição do protocolo da triagem auditiva para neonatos de risco?

How should hyperbilirubinemia be considered in the definition of the hearing screening protocol for neonates at risk?

Kátia de Freitas Alvarenga; Anna Paula Dionizio da Silva Campelo; Marina Saes Rays; Alice Andrade Lopes Amorim; Eliene Silva Araújo; Lilian Cassia Bornia Jacob

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Resumo

RESUMO: Objetivo: Analisar a hiperbilirrubinemia como indicador para a realização do protocolo de risco na triagem auditiva neonatal (TAN) e no monitoramento auditivo em neonatos a termo e prematuros.

Método: Trata-se de um estudo observacional, transversal e retrospectivo. Foram incluídas 554 crianças nascidas em uma maternidade pública, subdivididas em dois grupos: (G1) com 373 recém-nascidos a termo; (G2) com 181 neonatos prematuros. Os dados foram coletados nos prontuários dos participantes, a fim de se obter informações referentes ao resultado da TAN realizada por meio do registro do Potencial Evocado Auditivo de Tronco Encefálico, às condições de nascimento, características clínicas, intervenções realizadas, resultados do primeiro exame de bilirrubina total (BT) e bilirrubina indireta (BI) e do pico de BT e BI. Realizou-se análise estatística descritiva e inferencial dos dados, com adoção do nível de significância de 5%.

Resultados: No teste da TAN, foram observadas taxas de encaminhamento para reteste inferiores no G1 em relação ao G2. Não houve diferença entre os grupos quanto à ocorrência do tipo de parto, sexo, presença de incompatibilidade sanguínea Rh e ABO, deficiência de enzima G6PD e realização de fototerapia. Em relação aos níveis de BT e BI no primeiro exame e no momento do pico, não houve diferenças entre os neonatos com resultado “passa” e “falha” na TAN-teste nos dois grupos.

Conclusão: Os níveis de bilirrubina no período neonatal abaixo dos valores recomendados para indicação de exsanguineotransfusão não estão diretamente relacionados ao resultado “falha” na TAN em neonatos a termo e prematuros.

Palavras-chave

Hiperbilirrubinemia, Icterícia, Perda Auditiva, Bilirrubina, Recém-Nascido

Abstract

Purpose: To analyze hyperbilirubinemia as an indicator for the definition of risk protocol in newborn hearing screening (NHS) and in auditory monitoring in full-term and preterm neonates.

Methods: This is an observational, cross-sectional and retrospective study. A total of 554 children born in a public maternity hospital were included and divided into two groups: (G1) with 373 full-terms neonates; (G2) with 181 preterm neonates. Data were collected from the participant’s medical records to obtain information regarding the result of the NHS, performed by recording the automated auditory brainstem response (AABR), birth conditions, clinical characteristics, interventions performed, and results of the first test of total bilirubin (TB) and indirect bilirubin (IB) as well as the peak of TB and IB. A descriptive statistical analysis of the results was performed, and the level of significance adopted was 5%.

Results: On the NHS test, quotes of retest referral rates were smaller in G1 when compared to G2. There was no significant difference between the groups regarding type of delivery, gender, presence of Rh and ABO incompatibility, G6PD enzyme deficiency, and performance of phototherapy. TB and IB levels at the first exam and at peak time did not differ between neonates with “pass” and “fail” results on the NHS test in both groups.

Conclusion: Bilirubin levels in the neonatal period below the recommended values for indication of exchange transfusion are not directly related to the “fail” result on the NHS tests in term and preterm neonates.

Keywords

Hyperbilirubinemia; Jaundice; Hearing Loss; Bilirubin; Infant

Referencias

1 JICH: Joint Committee on Infant Hearing. 1994 position statement [Internet]. Rockville: JICH; 1994 [citado em 2022 Set 29]. Disponível em: http://www.jcih.org/JCIH1994.pdf

2 Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Ações Programáticas Estratégicas. Diretrizes de Atenção da Triagem Auditiva Neonatal [Internet]. Brasília; 2012 [citado em 2022 Set 29]. Disponível em: www.saude.gov.br/bvs

3 Lewis DR, Marone SAM, Mendes BCA, Cruz OLM, Nóbrega M. Comitê multiprofissional em saúde auditiva: COMUSA. Rev Bras Otorrinolaringol. 2010;76(1):121-8. http://dx.doi.org/10.1590/S1808-86942010000100020. PMid:20339700.

4 JCIH: Joint Committee on Infant Hearing. Year 2019 position statement: principles and guidelines for early hearing detection and intervention programs. JEHI [Internet]. 2019 [citado em 2022 Set 29];4(2):1-44. Disponível em: https://digitalcommons.usu.edu/jehdi/vol4/iss2/1/

5 Alkén J, Håkansson S, Ekéus C, Gustafson P, Norman M. Rates of extreme neonatal hyperbilirubinemia and kernicterus in children and adherence to national guidelines for screening, diagnosis, and treatment in Sweden. JAMA Netw Open. 2019;2(3):e190858. http://dx.doi.org/10.1001/jamanetworkopen.2019.0858. PMid:30901042.

6 Amin SB, Saluja S, Saili A, Orlando M, Wang H, Laroia N, et al. Chronic auditory toxicity in late preterm and term infants with significant hyperbilirubinemia. Pediatrics. 2017;140(4):e20164009. http://dx.doi.org/10.1542/peds.2016-4009. PMid:28954873.

7 Okumura A, Kitai Y, Arai H, Hayakawa M, Maruo Y, Kusaka T, et al. Auditory brainstem response in preterm infants with bilirubin encephalopathy. Early Hum Dev. 2021;154:105319. http://dx.doi.org/10.1016/j.earlhumdev.2021.105319. PMid:33530022.

8 Hegyi T, Kleinfeld A. Neonatal hyperbilirubinemia and the role of unbound bilirubin. J Matern Fetal Med. 2022;35(25):9201-7. http://dx.doi.org/10.1080/14767058.2021.2021177. PMid:34957902.

9 De Siati RD, Rosenzweig F, Gersdorff G, Gregoire A, Rombaux P, Deggouj N. Auditory neuropathy spectrum disorders: from diagnosis to treatment: literature review and case reports. J Clin Med. 2020;9(4):1074. http://dx.doi.org/10.3390/jcm9041074. PMid:32290039.

10 Gohari N, Emami SF, Mirbagheri SS, Valizadeh A, Abdollahi N, Borzuei M. The Prevalence and Causes of Auditory Neuropathy/Dys-synchrony (AN/AD) in Children with Hearing Impairment. Indian J Otolaryngol Head Neck Surg. 2019;71(1):71-5. http://dx.doi.org/10.1007/s12070-018-1494-1. PMid:30906717.

11 Umashankar A, Rajavenkat S, Chandrasekaran P. Bionic hearing in auditory neuropathy spectrum disorder: A systematic review. Indian J Otol. 2021;27(4):169. http://dx.doi.org/10.4103/indianjotol.indianjotol_29_21.

12 Hu J, Zhou X, Guo Y, Liu Y, Li Y, Jin X, et al. Auditory and verbal skills development post-cochlear implantation in Mandarin children with auditory neuropathy: a follow-up study. Acta Otolaryngol. 2022;142(2):175-81. http://dx.doi.org/10.1080/00016489.2022.2026465. PMid:35085477.

13 Dionis I, Chillo O, Bwire GM, Ulomi C, Kilonzi M, Balandya E. Reliability of visual assessment of neonatal jaundice among neonates of black descent: a cross-sectional study from Tanzania. BMC Pediatr. 2021;21(1):383. http://dx.doi.org/10.1186/s12887-021-02859-x. PMid:34479515.

14 John S, Pratt DS. Icterícia. In: Kasper DL, Hauser SL, Jameson JL, Fauci AS, Longo DL, Loscalzo J, editores. Medicina interna de Harrison. Porto Alegre: AMGH; 2017. Capítulo 58.

15 Kemper AR, Newman TB, Slaughter JL, Maisels MJ, Watchko JF, Downs SM, et al. Clinical practice guideline revision: management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics. 2022;150(3):e2022058859. http://dx.doi.org/10.1542/peds.2022-058859. PMid:35927462.

16 Thanomsingh P. Clinical predictive score of predischarge screening for severe hyperbilirubinemia in late preterm and term infants. Pediatr Neonatol. 2020;61(4):378-84. http://dx.doi.org/10.1016/j.pedneo.2020.02.003. PMid:32156481.

17 Boskabadi H, Zakerihamidi M, Moradi A, Bakhshaee M. Risk factors for sensorineural hearing loss in neonatal hyperbilirubinemia. Iran J Otorhinolaryngol. 2018;30(99):195-202. PMid:30083525.

18 Enk I, Andres L, Enk FL. Icterícia neonatal. In: Burns DAR, Campos D Jr, Silva LR, Borges WG, Blank D, editores. Tratado de Pediatria. Barueri: Manole; 2017. Capítulo 8; p. 1262-7.

19 Wolkoff AW. Hiperbilirrubinemias. In: Kasper DL, Hauser SL, Jameson JL, Fauci AS, Longo DL, Loscalzo J, editores. Medicina interna de Harrison. 19ª ed. Porto Alegre: AMGH; 2017. Capítulo 359.

20 Ding Y, Wang S, Guo R, Zhang A, Zhu Y. High levels of unbound bilirubin are associated with acute bilirubin encephalopathy in post-exchange transfusion neonates. Ital J Pediatr. 2021;47(1):187. http://dx.doi.org/10.1186/s13052-021-01143-z. PMid:34526082.

21 Xu J, Weng M, Li N, Wu X, Gao L, Yao H, et al. Relationship research between auditory neuropathy spectrum disorder and exchange transfusion in neonates with severe hyperbilirubinemia. Int J Pediatr Otorhinolaryngol. 2019;123:146-50. http://dx.doi.org/10.1016/j.ijporl.2019.04.044. PMid:31103744.

22 Nam G-S, Kwak SH, Bae SH, Kim SH, Jung J, Choi JY. Hyperbilirubinemia and follow-up auditory brainstem responses in preterm infants. Clin Exp Otorhinolaryngol. 2019;12(2):163-8. http://dx.doi.org/10.21053/ceo.2018.00899. PMid:30404412.

23 Hegyi T, Chefitz D, Weller A, Huber A, Carayannopoulos M, Kleinfeld A. Unbound bilirubin measurements in term and late-preterm infants. J Matern Fetal Neonatal Med. 2022;35(8):1532-8. http://dx.doi.org/10.1080/14767058.2020.1761318. PMid:32366186.

24 Teixeira MH, Borges VMS, Riesgo RS, Sleifer P. Hyperbilirubinemia impact on newborn hearing: a literature review. Rev Assoc Med Bras. 2020;66(7):1002-8. http://dx.doi.org/10.1590/1806-9282.66.7.1002. PMid:32844928.

25 Ciorba A, Hatzopoulos S, Corazzi V, Cogliandolo C, Aimoni C, Bianchini C, et al. Newborn hearing screening at the Neonatal Intensive Care Unit and Auditory Brainstem Maturation in preterm infants. Int J Pediatr Otorhinolaryngol. 2019;123:110-5. http://dx.doi.org/10.1016/j.ijporl.2019.05.004. PMid:31096068.
 


Submitted date:
04/11/2022

Accepted date:
11/04/2023

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