RESUMEN
Background: Neonatal hyperbilirubinemia is the most common condition that requires medical attention in newborns. The phenomenon of deposited indirect bilirubin in basal ganglia as well as in the vestibule-cochlear nucleus causes a neurological syndrome called kernicterus as well as sensorineural hearing loss. Currently, the most sensitive means of assessing neurotoxicity may be auditory brain stem evoked response [ABR], which shows the predictable early effects of bilirubin toxicity
Aim: This study aims to determine the effect of neonatal hyperbilirubinemia on auditory brainstem response [ABR] and evaluate the effect of treatment of hyperbilirubinemia on ABR findings
Subjects and Methods: This case-control study was performed on30 neonates with pathologic hyperbilirubinemia as the jaundiced group chosen from Neonatal Intensive Care Unit of AL Zahraa Hospital of Al-Azhar University and 20 healthy neonates as the control group chosen from Maternity department of the same hospital during the period from September, 2011 to August, 2012. ABR was performed on both groups. The evaluated variable factors were latency time, inter peak intervals time
Results: The mean latencies of waves I, III and V of ABR were significantly higher in the pathologic hyperbilirubinemia group as compared with the controls and the mean interpeak intervals [IPI] of waves I-III, I-V and III-V of ABR were significantly higher in the pathologic hyperbilirubinemia group as compared with the controls. A total reversibility to normal thresholds [normal hearing] was displayed by 23 [77.00%] and 25 [83.30%] of jaundiced neonates in the right and left ears respectively, while the remaining 7 [23.00%] and 5 [16.70%] of jaundiced neonates displayed partial reversibility [mild to moderate hearing loss] in the right and left ears respectively [p <0"001]
Conclusions: About 90% of neonates with pathologic hyperbilirubinemia demonstrate ABR changes. Most of these changes [about 77%] revert to normal early after therapy
RESUMEN
Neonatal septicemia is one of the most important causes of mortality and morbidity . in NICU and NCCU. A few studies had been found in the midline regarding the hepatic functions during neonatal septicemia. The aim of this work is to investigate the impact of neonatal infection on hepatic function tests ,hepatic ultrasonography and hepatic blood flow in the hepatic artery, hepatic vein and portal vein.This study included forty newborn infants attended neonatal IC U due to neonatal sepsis as well as ten normal newborn .Cases had early and late manifestations of sepsis with laboratory picture of infection. All cases were subjected to complete history taking and clinical evaluation. Estimation of CBCCRP, blood gases,electrolytes, blood glucose and liver function tests .Abdominal ultrasound was done to evaluate liver and hepatic blood flow in the hepatic artery, hepatic vein and portal vein.Our results showed significant differences between control and septic group regarding postnatal age,P<0.016,total WBCs counts,P <0.001 and significant decrease in platelets counts,P<0.001, total protein, P0.015 .There was significant increase in total and direct bilirubin as P<0.001 and 0.006 respectively. There was significant elevation in the serumAlkaline phosphatase in the septic group,P <0.005 as well as the ALT P<0.029 and significant prolongation of PTamong two groups, P 0.055. Blood glucose showed non significant decrease from the control group.Our results showed also significant differences between early and late sepsis subgroups as there were; increase in the mean values of total Wbcs P< 0. 001, total protein P<0.0.009,albumin P< 0.001, direct bilirubin P <0.032.Regarding study on hepatic blood flow our results have shown a significant increase in the hepatic artery mean velocity mean values among septic group than the control group P.<0.002,this increase was significantly higher, during early infection than late infection cases, P <0.001.Hepatic vein blood flow mean values was significantly elevated than the control group P< 0.001 which may reflect decrease in the Resistivity Index[RI] among the septic group than control cases P<0.02.Portal vein Mv mean values was not significantly elevated among the all septic group ,but it was significantly higher among early septic cases than late septic cases, P 0.006 . We conclude that changes in the hepatic hemodynamic during infection may affect the metabolic and detoxification functions of the liver during neonatal septicemia .A reduction of drug doses may be of must, hepatic support also should be overlooked