Abstract
Introduction:
This study was a two-center, stratified, parallel-group randomized trial comparing the effects of aggressive vs. conservative phototherapy on brainstem auditory evoked response (BAER) latencies in infants with extremely low birth weight (ELBW, ≤ 1,000 g).
Results:
BAER latencies of 751–1,000 g birth-weight infants were shorter by 0.37 ms (95% confidence interval (CI) = 0.02, 0.73) for wave V, 0.39 ms (0.08, 0.70) for wave III, and 0.33 ms (0.01, 0.65) for wave I after aggressive phototherapy at one center. Interwave intervals did not differ significantly. Similar nonsignificant trends were recorded for 501–750 g birth-weight infants. At the other participating center, no significant differences were recorded, cautioning against overgeneralizing these results.
Discussion:
The effects of bilirubin on the auditory pathway in ELBW infants depend on a complex interaction of bilirubin exposure, newborn characteristics, and clinical management.
Methods:
Aggressive phototherapy was initiated sooner and continued at lower bilirubin levels than conservative phototherapy. A total of 174 ELBW infants were enrolled in the study; 111 infants were successfully tested at 35 weeks postmenstrual age (PMA); 57 died; and 6 were not successfully tested.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Scheidt PC, Bryla DA, Nelson KB, Hirtz DG, Hoffman HJ . Phototherapy for neonatal hyperbilirubinemia: six-year follow-up of the National Institute of Child Health and Human Development clinical trial. Pediatrics 1990;85: 455–63.
Brown AK, Kim MH, Wu PY, Bryla DA . Efficacy of phototherapy in prevention and management of neonatal hyperbilirubinemia. Pediatrics 1985;75(2 Pt 2): 393–400.
Morris BH, Oh W, Tyson JE, et al.; NICHD Neonatal Research Network. Aggressive vs. conservative phototherapy for infants with extremely low birth weight. N Engl J Med 2008;359: 1885–96.
Shapiro SM, Nakamura H . Bilirubin and the auditory system. J Perinatol 2001;21 Suppl 1: S52–5; discussion S59–62.
Ponton CW, Moore JK, Eggermont JJ . Auditory brain stem response generation by parallel pathways: differential maturation of axonal conduction time and synaptic transmission. Ear Hear 1996;17: 402–10.
Kuriyama M, Konishi Y, Sudo M . Auditory brainstem response in hyperbilirubinemic rat: Part I. Biol Neonate 1990;58: 32–40.
Haustein MD, Read DJ, Steinert JR, Pilati N, Dinsdale D, Forsythe ID . Acute hyperbilirubinaemia induces presynaptic neurodegeneration at a central glutamatergic synapse. J Physiol (Lond) 2010;588(Pt 23): 4683–93.
Hansen TW . Twists and turns in phototherapy for neonatal jaundice. Acta Paediatr 2010;99: 1117–8.
Mreihil K, McDonagh AF, Nakstad B, Hansen TW . Early isomerization of bilirubin in phototherapy of neonatal jaundice. Pediatr Res 2010;67: 656–9.
Moller AR, Jannetta PJ . Neural generators of the auditory brainstem response. In: Jacobson JT (ed), The Auditory Brainstem Response. San Diego: College-Hill Press, 1985: 13–31.
Lasky RE . A developmental study on the effect of stimulus rate on the auditory evoked brain-stem response. Electroencephalogr Clin Neurophysiol 1984;59: 411–9.
Rogers WH . Regression standard errors in clustered samples. Stata Tech Bull 1993;13: 19–23.
Tobin J . Estimation of relationships for limited dependent variables. Econometrica 1958;26: 24–36.
Acknowledgements
We are indebted to our medical and nursing colleagues and the infants and their parents who agreed to take part in this study. The following institutions and investigators, in addition to those listed as authors, participated in this study. Alan Jobe, University of Cincinnati (NRN Chair, 2001–2006). Alpert Medical School of Brown University and Women & Infants Hospital of Rhode Island (U10 HD27904). Cincinnati Children’s Hospital Medical Center University Hospital and Good Samaritan Hospital (U10 HD27853, M01 RR8084). Linda L. Wright, Elizabeth M. McClure: Eunice Kennedy Shriver National Institute of Child Health and Human Development. W. Kenneth Poole, Betty Hastings, John C. Langer, Rebecca L. Perritt, Qing Yao, Carolyn Petrie Huitema, Sarah Taylor, and Kristin Zaterka-Baxter: RTI International (U10 HD36790). Stanford University Dominican Hospital, El Camino Hospital, and Lucile Packard Children’s Hospital (U10 HD27880, M01 RR70). University of Rochester Medical Center Golisano Children’s Hospital (U10 HD40521, M01 RR44). Kathleen A. Kennedy, Esther G. Akpa, Patty A. Cluff, Anna E. Lis, Claudia Y. Franco, Maegan Currence, Nora I. Alaniz, and Patti L. Pierce Tate: University of Texas Health Science Center at Houston, Medical School, Children’s Memorial Hermann Hospital, and Lyndon B. Johnson General Hospital (CCTS KL2 RR24149, CCTS UL1 RR24148, U10 HD21373). Wake Forest University Baptist Medical Center, Brenner Children’s Hospital, and Forsyth Medical Center (U10 HD40498, M01 RR7122). Rebecca Bara and Geraldine Muran: Wayne State University Hutzel Women’s Hospital and Children’s Hospital of Michigan (U10 HD21385).
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Lasky, R., Church, M., Orlando, M. et al. The effects of aggressive vs. conservative phototherapy on the brainstem auditory evoked responses of extremely-low-birth-weight infants. Pediatr Res 71, 77–84 (2012). https://doi.org/10.1038/pr.2011.17
Received:
Accepted:
Published:
Issue date:
DOI: https://doi.org/10.1038/pr.2011.17
