The Relationship Between Treatment of NICU Infants with Phototherapy and Intralipids and Auditory Brainstem Responses

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ESPR446
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Background: Hyperbilirubinemia occurs in about 50% of full-term and 80% of preterm infants. Phototherapy is a common treatment for reducing bilirubin levels. Auditory brainstem evoked responses (ABR) have been the gold standard for assessing the neurotoxic effects of excess bilirubin on neural transmission from the auditory nerve to the auditory brainstem nuclei, structures highly susceptible to hyperbilirubinemia. ABR alterations observed in relation to bilirubin neurotoxicity include prolongation of absolute latencies of waves I, III, and V, and of inter-wave intervals (e.g., Amin et al, 2001). Relatedly, researchers (Hegyi et al, 2020) have recently raised concerns that intralipid treatment, used in parenteral nutrition for preterm infants, may interfere with bilirubin binding, thus increasing the risk of bilirubin-induced neurotoxicity. 

Objective: To examine the relationship between treatment of NICU infants with phototherapy and intralipids and neural transmission assessed by ABR.

Design/MethodsData from a subset of participants in a study of high risk NICU infants were analyzed. To account for the tendency for ABRs to normalize with age, participants had two ABRs, one within 2 weeks of birth and the second close to discharge (N=98; 51% male; EGA= 32±3.7; BW=1683±741). ABR absolute and inter-wave latencies were analyzed as numerical and categorical values (normal vs prolonged). Chi-square was used to analyze the relationship between ABR and phototherapy, and regression between ABR and intralipid treatment.  

ResultsSignificantly more infants in the phototherapy group were also in the prolonged ABR group at time1, with prolonged latencies of wave I, I-III and III-V intervals (X2(1, N=98) = 6.51; 4.03; 6.58, respectively; p<.05), but there was no relationship between an abnormal second ABR and phototherapy. However, intralipid treatment and ABRs were consistently related. At both timepoints, Wave V latencies were prolonged in the group receiving intralipids (t=-2.49, p=0.015; t=-2.10, p=0.038 respectively).

Conclusions:  NICU infants who received phototherapy, a proxy for hyperbilirubinemia, exhibited a positive relationship between hyperbilirubinemia and an abnormal ABR, but this relationship was not sustained on a subsequent ABR at older ages. On the other hand, we observed a relationship between intralipid treatment and a prolonged Wave V latency at two timepoints across the pre-natal period. Given that prolongation of ABR Wave V has previously been associated with bilirubin toxicity, this observation is consistent with concerns raised in relation to intralipid treatment possibly interfering with bilirubin binding. This preliminary finding may have implications for close monitoring of infants treated with intralipids for early signs of neural impairments and for the potential utility of ABRs for such monitoring.



NYS Institute for Basic Research in Developmental Disabilities
NYS Institute for Basic Research in Developmental Disabilities
Richmond University Medical Center
Richmond University Medical Center
NYS Institute for Basic Research in Developmental Disabilities
NYS Institute for Basic Research in Developmental Disabilities
NYS Institute for Basic Research in Developmental Disabilities
Richmond University Medical Center

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