Neurological impairment of children with history of prematurity and neonatal hyperbilirubinemia
Keywords:
children, neurological impairment, premature, hyperbilirubinemia
Abstract
Background In premature infants, the incidence of hyperbiliru-binemia is still high. Bilirubin encephalopathy can develop without
marked hyperbilirubinemia.
Objective To know the incidence of neurological impairment in
premature with hyperbilirubinemia and the association between
neurological impairment and serum unconjugated billirubin con-
centration.
Methods A retrospective study was conducted on 54 prematures
with history of hyperbilirubinemia and 54 without history of hyper-
bilirubinemia born between 1997 and 1998 and discharged from
Sanglah Hospital. Consecutive sampling was done. After univariate
analysis, multivariate analysis was used to identify the association
between serum unconjugated bilirubin concentration and neuro-
logical impairment at the adjusted age of 318 months.
Results There were statistically significant differences in mean of
age and neurological impairment between subjects with and with-
out hyperbilirubinemia (p<0.0001 and 0.026). In subjects with hy-
perbilirubinemia, univariate analysis showed significant differences
in means of serum unconjugated bilirubin concentration, gesta-
tional age, birth weight, and serum albumin concentration between
subject who had neurological impairment and who had no neuro-
logical impairment with p = 0.005; 0.001; 0.002; <0.0001, respec-
tively. Multivariate analysis found there were association between
neurological impairment and serum unconjugated bilirubin concen-
tration, gestational age, and serum albumin concentration with
p<0.0001; 0.004; and <0.0001, respectively.
Conclusion Neurological impairment in subject with hyperbiliru-
binemia was greater than subject without hyperbilirubinemia. Se-
rum unconjugated bilirubin concentration is one of three factors
that associated with neurological impairment
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peningkatan kualitas sumber daya manusia. Naskah
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fants: current prevalence and relationship to NICHD
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a generation ago. Pediatrics 1992;89:819-20.
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toxicity. Pediatrics 1992;89:823-4.
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new standard of care? Pediatrics 1992;89:824-6.
23. Gartner LM. Management of jaundice in the well
baby. Pediatrics 1992;89:826-7.
24. Newman TB, Maisels MJ. Response to commentaries
re-evaluation and treatment of jaundice in the term
newborn: a kinder, gentler approach. Pediatrics
1992;89:831-33.
25. Rodgers PA, Stevenson DK. Developmental biol-
ogy of heme oxigenase. Clin Perinatol
1990;17:275-91.
26. Rendle -Short J, Gray OP, Dodge JA. Ikhtisar
penyakit anak. 6 th ed. Jakarta: Binarupa Aksara,
1994. p. 60-5
27. Oski FA. Physiologic jaundice. In: Avery ME,
Taeusch HW, editors. Schaffer’s disease of the new-
born. 5 th ed. Philadelphia: WB Saunders, 1984. p.
360-79
28. Gourley GR. Bilirubin metabolism and neonatal jaun-
dice. In: Suchy FD, editor. Liver disease in children.
St. Louis: Mosby, 1994. p. 105-25.
29. Maisels MJ, Newman TB. Kernicterus in otherwise
healthy, breast-fed term newborns. Pediatrics 1995;
96:730-33.
30. Scheidt PC, Mellits D, Hardy JB, Drage JS, Boggs
TR. Toxicity to bilirubin in neonates: infant devel-
opment during first year in relation to maximum neo-
natal serum bilirubin concentration. J Pediatr 1977;
91:292-7.
31. Van de Bor M, va Zeben-van der Aa TM, Verloope-
Vahorick SP, Brand R, Ruys JH. Hyperbilirubinemia
in preterm infants and neurodevelopment outcome
at 2 years of age: results of a national collaborative
study. Pediatrics 1989;83:915-20.
32. O’Shea TM, Dillard RG, Klinepeter KL, Goldstein
DJ. Serum bilirubin level, intracranial hemor-
rhage, and the risk of developmental problems in
very low birth weight neonates. Pediatrics
1992;90:888-92.
33. Frank CG, Turner BS, Merenstein GB. Jaundice. In:
Merenstein GB, Gardner SL, editors. Handbook of
neonatal intensive care. 3 rd ad. St. Louis: Mosby;
1993. p. 272-85.
34. Aldoretta PW, Spedale SB. Neonatal hyperbilirubine-
mia. In: Merenstein GB. Kaplan DW, Rosenberg AA,
editors. Handbook of pediatric. 18 th ed. Stamford:
Appleton & Lange; 1997. p. 155-59.
35. Cashore WJ. The Neurotoxicity of bilirubin. Clin
Perinatol 1990;17:437-47.
tumbuh kembang anak. Presented at Pra raker
Ikatan Dokter Anak Indonesia; 1999 December 1;
Yogyakarta, Indonesia.
2. Palmer C, Smith MB. Assessing the risk of kernicterus
using nuclear magnetic resonance. Clin Perinatol
1990;17:307-29.
3. Monintja HE. Sikap rasional terhadap ikterus neona-
torum non obstruktif. In: Yu VYH, Monintja HE, edi-
tors. Beberapa masalah perawatan intensif neonatus.
Jakarta: BP FKUI; 1997. p. 231-43.
4. Bratlid D. How bilirubin gets into the brain. Clin
Perinatol 1990;17:449-65.
5. Volpe JJ. Neurology of the newborn. 2 nd ed. Philadel-
phia: WB Saunders; 1987. p. 387-404.
6. Aminullah A. Ikterus dan hiperbilirubinemia pada
neonatus. In: Markum AH, Ismael S, Alatas H, et al,
editors. Buku Ajar Ilmu Kesehatan Anak. Jakarta: BP
FKUI; 1996. p. 313-7.
7. Connolly AM, Volve JJ. Clinical feature of bilirubin
encephalopathy. Clin Perinatol 1990;17:371-9.
8. Menkes JH, Till K. Kernicterus. In: Menkes JH, edi-
tor. Textbook of child neurology. 4 th ed. Philadelphia:
Lea & Febiger; 1990. p. 506-9.
9. Wolf MJ, Beunen G, Casaer P. Neurological status in
severely jaundiced Zimbabwean neonates. J Trop
Pediatr 1998;44:161-4.
10. Wilson-Costello D, Borawski E, Friedman H. Perina-
tal correlates of cerebral palsy and other neurological
impairment among very low birth weight children.
Pediatrics 1998;102:315-22.
11. Doyle LW. Outcome of preterm infants. In: Suradi R,
Monintja HE, Amalia P, editors. Penanganan
mutakhir bayi prematur: memenuhi kebutuhan bayi
prematur untuk menunjang peningkatan kualitas
sumber daya manusia. Naskah lengkap Pendidikan
Kedokteran Berkelanjutan Ilmu Kesehatan Anak
FKUI XXXVIII FKUI; 1997 April 7-8; Jakarta.
Jakarta: BP FKUI;1997.
12. Soetomenggolo TS. Hiperbilirubinemia. In: Suradi R,
Monintja HE, Amalia P, editors. Penanganan
mutakhir bayi prematur: memenuhi kebutuhan bayi
prematur untuk menunjang peningkatan kualitas
sumber daya manusia. Naskah lengkap Pendidikan
Kedokteran Berkelanjutan Ilmu Kesehatan Anak
FKUI XXXVIII FKUI; 1997 April 7-8; Jakarta.
Jakarta: BP FKUI; 1997.
13. Wibowo N. Risiko dan pencegahan kelahiran
prematur. In: Suradi R, Monintja HE, Amalia P, edi-
tors. Penanganan mutakhir bayi prematur: me-
menuhi kebutuhan bayi prematur untuk menunjang
peningkatan kualitas sumber daya manusia. Naskah
lengkap Pendidikan Kedokteran Berkelanjutan Ilmu
Kesehatan Anak FKUI XXXVIII FKUI; 1997 April
7-8; Jakarta. Jakarta: BP FKUI; 1997.
14. Yeo KL, Perlman M, Hao Y, Mullaney P. Outcomes of
extremely premature infants related to their peak se-
rum bilirubin concentration and exposure to photo
therapy. Pediatrics 1998;102:1426-31.
15. Behrman RE, Kliegman RM. Jaundice and hyperbi-
lirubinemia in the newborn. In: Behrman RE,
Kliegman RM, Arvin AM, editors. Nelson textbook
of pediatrics. 15 th ed. Philadelphia: WB Saunders;
1996. p. 493-6.
16. Johnson L. Yet another expert opinion on bilirubin
toxicity. Pediatrics 1992 89:829-31.
17. Soetomenggolo TS, Iman S. Kernikterus (ensefalopati
bilirubin akut). In: Soetomenggolo TS, Ismael S, edi-
tors. Buku ajar neurologi anak. Jakarta: BP IDAI;
1999. p. 541-3.
18. Watchko JF, Claassen D. Kernicterus in premature in-
fants: current prevalence and relationship to NICHD
photo therapy study exchange criteria. Pediatrics
1994; 93:996-9.
19. Valaes T. Bilirubin toxicity: The problem was solved
a generation ago. Pediatrics 1992;89:819-20.
20. Merenstein GB. New bilirubin recommendations
questioned. Pediatrics 1992;89:822-3.
21. Poland RL. In search of a gold standard for bilirubin
toxicity. Pediatrics 1992;89:823-4.
22. Cashore WJ. Hyperbilirubinemia: should we adopt a
new standard of care? Pediatrics 1992;89:824-6.
23. Gartner LM. Management of jaundice in the well
baby. Pediatrics 1992;89:826-7.
24. Newman TB, Maisels MJ. Response to commentaries
re-evaluation and treatment of jaundice in the term
newborn: a kinder, gentler approach. Pediatrics
1992;89:831-33.
25. Rodgers PA, Stevenson DK. Developmental biol-
ogy of heme oxigenase. Clin Perinatol
1990;17:275-91.
26. Rendle -Short J, Gray OP, Dodge JA. Ikhtisar
penyakit anak. 6 th ed. Jakarta: Binarupa Aksara,
1994. p. 60-5
27. Oski FA. Physiologic jaundice. In: Avery ME,
Taeusch HW, editors. Schaffer’s disease of the new-
born. 5 th ed. Philadelphia: WB Saunders, 1984. p.
360-79
28. Gourley GR. Bilirubin metabolism and neonatal jaun-
dice. In: Suchy FD, editor. Liver disease in children.
St. Louis: Mosby, 1994. p. 105-25.
29. Maisels MJ, Newman TB. Kernicterus in otherwise
healthy, breast-fed term newborns. Pediatrics 1995;
96:730-33.
30. Scheidt PC, Mellits D, Hardy JB, Drage JS, Boggs
TR. Toxicity to bilirubin in neonates: infant devel-
opment during first year in relation to maximum neo-
natal serum bilirubin concentration. J Pediatr 1977;
91:292-7.
31. Van de Bor M, va Zeben-van der Aa TM, Verloope-
Vahorick SP, Brand R, Ruys JH. Hyperbilirubinemia
in preterm infants and neurodevelopment outcome
at 2 years of age: results of a national collaborative
study. Pediatrics 1989;83:915-20.
32. O’Shea TM, Dillard RG, Klinepeter KL, Goldstein
DJ. Serum bilirubin level, intracranial hemor-
rhage, and the risk of developmental problems in
very low birth weight neonates. Pediatrics
1992;90:888-92.
33. Frank CG, Turner BS, Merenstein GB. Jaundice. In:
Merenstein GB, Gardner SL, editors. Handbook of
neonatal intensive care. 3 rd ad. St. Louis: Mosby;
1993. p. 272-85.
34. Aldoretta PW, Spedale SB. Neonatal hyperbilirubine-
mia. In: Merenstein GB. Kaplan DW, Rosenberg AA,
editors. Handbook of pediatric. 18 th ed. Stamford:
Appleton & Lange; 1997. p. 155-59.
35. Cashore WJ. The Neurotoxicity of bilirubin. Clin
Perinatol 1990;17:437-47.
Published
2016-10-10
How to Cite
1.
Subanada I, Kari I, Hamid A. Neurological impairment of children with history of prematurity and neonatal hyperbilirubinemia. PI [Internet]. 10Oct.2016 [cited 25Apr.2024];43(2):59-5. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/660
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Received 2016-09-22
Accepted 2016-09-22
Published 2016-10-10
Accepted 2016-09-22
Published 2016-10-10
