Effect of Neonatal Hyperbilirubinemia on Cerebral Cortical Activity and Neurodevelopment

Abstract

Severe neonatal hyperbilirubinemia, with consequent encephalopathy, remains a common cause of morbidity and death in developing countries so the challenge is to early detect and promptly treat hyperbilirubinemia to prevent adverse neurologic outcome. The aim of this work to study the effect of hyperbilirubinemia on neonatal cerebral cortical activity and demonstrate the electroen-cephalographic maturational changes after therapy and 2ndry aim to study neurodevelopment outcome and its correlation with EEG changes. This study was a prospective observational study done in NICU of Ain Shams university hospitals during the period (from June 2012 to June, 2013). It included 50 newborns (37-40) weeks (30 males – 20 females) suffering from severe hyperbilirubinemia >20mg/dl. All the studied neonates were subjected to: thorough history taking (antenatal, natal and postnatal history), full clinical examination. Neurological assessment applying Ameil-Tison Neurological Assessment (ATNA) and also BIND score done on admission, Neurodevelopmental assessment was done at 3 and 6 months of age including head control, social smile, response to sound and eye contact using Bayley scale of infants and toddlers 3rd edition. In addition to follow up ATNA was done also at 3 and 6 months of age. An initial base line EEG examination was performed during phototherapy, another follow up EEG at 3 and 6 months of age. Each recording was for I hour to include full cycle of quite and active sleep. In our study The EEG has been used to study the maturation of the brain as the infant grows in the first year of life, as well as to identify abnormalities in cerebral electrical activity including delays of the normal maturation sequence, cerebrocortical activity was recorded as indicator of bilirubin neurotoxicity, brain maturation was also analysed through detection of hyperbilirubinemia on sleep spindle Laboratory investigations including serum biliurbin, hemoglobin, hematocrit, blood group of the baby and the mother, reticulocyte count and Coomb's test. Treatment implemented whether exchange transfusion or intensive phototherapy was recorded.