摘要
BACKGROUND： Brainstem auditory evoked potential （BAEP） has been widely used to evaluate the functional integrity and development of injured auditory system and brain, especially to objectively evaluate the function of auditory system and brain stem of very young babies, such as neonates and sick babies. OBJECTIVE： To observe the changes of BAEP of neonates with hyperbilirubinemia, and to investigate the relationship of bilirubin concentration and BAEP. DESIGN： An observation experiment. SETTING： Department of Pediatrics, the 309 Clinical Division, General Hospital of Chinese PLA. PARTICIPANTS： Fifty-eight neonates with mild or moderate hyperbilirubinemia exhibiting jaundice within 24 hours after born, who received the treatment in the Department of Pediatrics, the 309 Clinical Division, General Hospital of Chinese PLA between January 2004 and May 2007, were recruited in this study. The involved neonates, 31 boys and 27 girls, had gestational age of 37 to 46 weeks. They had no history of birth asphyxia, and were scored 8 to 10 points when born. Written informed consents of examination and treatment were obtained from the guardians of the neonates. This study was approved by the Hospital Ethics Committee. According to serum total bilirubin value, the neonates were assigned into 3 groups： low-concentration bilirubin group （n =16）, moderate-concentration bilirubin group （n =27） and high-concentration bilirubin group （n =15）. According to mean daily bilirubin increase, the subjects were sub-assigned into bilirubin rapid increase group （n =39） and bilirubin slow increase group （n = 19）. METHODS： After admission, all the neonates received drug treatment. Meanwhile, their 116 ears were examined with a myoelectricity evoked potential equipment （KEYPOINT） in latency, wave duration, amplitude and wave shape differentiation of each wave of BAEP. BAEP abnormal type was observed and abnormal rate of BAEP was calculated. MAIN OUTCOME MEASURES： ①Abnormal rate and abnormal type of BAEP. ② Latency of waves Ⅰ , Ⅲ and Ⅴ, and wave duration of waves Ⅰ to Ⅲ,Ⅲ to Ⅴ, and Ⅰ to Ⅴ. RESULTS： Fifty-eight neonates with mild or moderate hyperbilirubinemia were involved in the final analysis. ①Abnormal type and abnormal rate of BAEP of neonates with hyperbilirubinemia： Among the 116 ears, unilateral or bilateral waves Ⅰ, Ⅲ,Ⅴ still existed. The latency of waves Ⅰ, Ⅲ and Ⅴ was ＋2.5 s longer than the normal level in 8, 4 and 15 ears, respectively. The wave duration of waves Ⅰ to Ⅲ and waves Ⅲ to Ⅴ was ＋2.5 s longer than the normal level in 6 and 14 ears, respectively. The wave duration of waves Ⅲ to Ⅴ was longer than that of ipsilateral waves Ⅰ to Ⅲ in 24 ears. The latency difference of wave Ⅴ between two ears was larger than 0.4 ms in 31 neonates with hyperbilirubinemia; The amplitude of wave Ⅴ to that of ipsilateral wave 1 was lower than 0.5 in 29 neonates. Totally 52 ears were abnormal, and the abnormal rate was 44.8%. One to two months later, 98% abnormal neonates with hyperbilirubinemia recovered. The abnormal rate in the low-, moderate-, and high-concentration bilirubin groups was 37.5%, 44.4% and 53.3%, respectively. ② Comparison of latency and wave duration of each wave of BAEP： Latency of waves Ⅰ, Ⅲ and Ⅴ, and wave duration of waves Ⅰ to III and Ⅲ to Ⅴ were gradually prolonged in low-, moderate-, and high-concentration bilirubin groups, but significant difference did not exist between two groups （P 〉 0.05）. ③ There were no significant differences in latency of waves Ⅰ, Ⅲand Ⅴ, and wave duration of waves Ⅰ to Ⅲ, Ⅲto Ⅴ and Ⅰ to Ⅴ between bilirubin rapid increase group and bilirubin slow increase group （P 〉 0.05）. CONCLUSION： Auditory acuity and brainstem of neonates with mild or moderate hyperbilirubinemia are damaged to some extent. High-concentration bilirubin causes BAEP abnormality easily. Bilirubin increase and its concentration change are not consistent with nervous lesion degree.
BACKGROUND： Brainstem auditory evoked potential （BAEP） has been widely used to evaluate the functional integrity and development of injured auditory system and brain, especially to objectively evaluate the function of auditory system and brain stem of very young babies, such as neonates and sick babies. OBJECTIVE： To observe the changes of BAEP of neonates with hyperbilirubinemia, and to investigate the relationship of bilirubin concentration and BAEP. DESIGN： An observation experiment. SETTING： Department of Pediatrics, the 309 Clinical Division, General Hospital of Chinese PLA. PARTICIPANTS： Fifty-eight neonates with mild or moderate hyperbilirubinemia exhibiting jaundice within 24 hours after born, who received the treatment in the Department of Pediatrics, the 309 Clinical Division, General Hospital of Chinese PLA between January 2004 and May 2007, were recruited in this study. The involved neonates, 31 boys and 27 girls, had gestational age of 37 to 46 weeks. They had no history of birth asphyxia, and were scored 8 to 10 points when born. Written informed consents of examination and treatment were obtained from the guardians of the neonates. This study was approved by the Hospital Ethics Committee. According to serum total bilirubin value, the neonates were assigned into 3 groups： low-concentration bilirubin group （n =16）, moderate-concentration bilirubin group （n =27） and high-concentration bilirubin group （n =15）. According to mean daily bilirubin increase, the subjects were sub-assigned into bilirubin rapid increase group （n =39） and bilirubin slow increase group （n = 19）. METHODS： After admission, all the neonates received drug treatment. Meanwhile, their 116 ears were examined with a myoelectricity evoked potential equipment （KEYPOINT） in latency, wave duration, amplitude and wave shape differentiation of each wave of BAEP. BAEP abnormal type was observed and abnormal rate of BAEP was calculated. MAIN OUTCOME MEASURES： ①Abnormal rate and abnormal type of BAEP. ② Latency of waves Ⅰ , Ⅲ and Ⅴ, and wave duration of waves Ⅰ to Ⅲ,Ⅲ to Ⅴ, and Ⅰ to Ⅴ. RESULTS： Fifty-eight neonates with mild or moderate hyperbilirubinemia were involved in the final analysis. ①Abnormal type and abnormal rate of BAEP of neonates with hyperbilirubinemia： Among the 116 ears, unilateral or bilateral waves Ⅰ, Ⅲ,Ⅴ still existed. The latency of waves Ⅰ, Ⅲ and Ⅴ was ＋2.5 s longer than the normal level in 8, 4 and 15 ears, respectively. The wave duration of waves Ⅰ to Ⅲ and waves Ⅲ to Ⅴ was ＋2.5 s longer than the normal level in 6 and 14 ears, respectively. The wave duration of waves Ⅲ to Ⅴ was longer than that of ipsilateral waves Ⅰ to Ⅲ in 24 ears. The latency difference of wave Ⅴ between two ears was larger than 0.4 ms in 31 neonates with hyperbilirubinemia; The amplitude of wave Ⅴ to that of ipsilateral wave 1 was lower than 0.5 in 29 neonates. Totally 52 ears were abnormal, and the abnormal rate was 44.8%. One to two months later, 98% abnormal neonates with hyperbilirubinemia recovered. The abnormal rate in the low-, moderate-, and high-concentration bilirubin groups was 37.5%, 44.4% and 53.3%, respectively. ② Comparison of latency and wave duration of each wave of BAEP： Latency of waves Ⅰ, Ⅲ and Ⅴ, and wave duration of waves Ⅰ to III and Ⅲ to Ⅴ were gradually prolonged in low-, moderate-, and high-concentration bilirubin groups, but significant difference did not exist between two groups （P 〉 0.05）. ③ There were no significant differences in latency of waves Ⅰ, Ⅲand Ⅴ, and wave duration of waves Ⅰ to Ⅲ, Ⅲto Ⅴ and Ⅰ to Ⅴ between bilirubin rapid increase group and bilirubin slow increase group （P 〉 0.05）. CONCLUSION： Auditory acuity and brainstem of neonates with mild or moderate hyperbilirubinemia are damaged to some extent. High-concentration bilirubin causes BAEP abnormality easily. Bilirubin increase and its concentration change are not consistent with nervous lesion degree.
