title: Novel treatment strategy for Japanese newborns with high serum unbound bilirubin.
abstract: BACKGROUND
  Serum unbound bilirubin (UB) is a measure of bilirubin not bound to albumin, and has been reported to be better than total bilirubin level at identifying infants at risk of developing bilirubin-induced neurotoxicity, including auditory abnormalities. A detailed treatment strategy for newborns with high serum UB has not been established. The aim of this study was to assess auditory outcomes in newborns with serum UB ≥1.00 μg/dL who were treated according to a novel treatment protocol.
  
  
  METHODS
  A prospective clinical study was conducted in newborns weighing >1500 g with serum UB ≥1.00 μg/dL who were admitted to Kobe University Hospital and Kakogawa Municipal Hospital, Japan from 2006 to 2011. Enrolled newborns were treated as follows: (i) if serum UB was 1.00-1.50 μg/dL, phototherapy and infusion were given with or without albumin or immunoglobulin therapy; and (ii) if serum UB was >1.50 μg/dL, exchange transfusion was performed immediately. Auditory brainstem responses were evaluated at the time of discharge.
  
  
  RESULTS
  A total of 89 Japanese newborns with UB ≥1.00 μg/dL were enrolled at a median age of 4 days. Of these, 85 had UB 1.00-1.50 μg/dL and four had UB >1.50 μg/dL. After being treated according to the protocol, no newborns were diagnosed with auditory brainstem response abnormalities.
  
  
  CONCLUSIONS
  The present treatment protocol for Japanese newborns with serum UB ≥1.00 μg/dL may be useful for the prevention of bilirubin-induced auditory abnormalities.
authors.affiliation: Department of Pediatrics, Kobe University Hospital, Kobe.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Yokota
authors.forename: Ichiro
authors.initials: I
authors.lastname: Morioka
authors.forename: Takayuki
authors.initials: T
authors.lastname: Kodera
authors.forename: Takeshi
authors.initials: T
authors.lastname: Morisawa
authors.forename: Itsuko
authors.initials: I
authors.lastname: Sato
authors.forename: Seiji
authors.initials: S
authors.lastname: Kawano
authors.forename: Tsubasa
authors.initials: T
authors.lastname: Koda
authors.forename: Kiyomi
authors.initials: K
authors.lastname: Matsuo
authors.forename: Kazumichi
authors.initials: K
authors.lastname: Fujioka
authors.forename: Satoru
authors.initials: S
authors.lastname: Morikawa
authors.forename: Akihiro
authors.initials: A
authors.lastname: Miwa
authors.forename: Akio
authors.initials: A
authors.lastname: Shibata
authors.forename: Naoki
authors.initials: N
authors.lastname: Yokoyama
authors.forename: Masahiko
authors.initials: M
authors.lastname: Yonetani
authors.forename: Hideto
authors.initials: H
authors.lastname: Yamada
authors.forename: Hajime
authors.initials: H
authors.lastname: Nakamura
authors.forename: Kazumoto
authors.initials: K
authors.lastname: Iijima
mesh_terms: D000418:Albumins / Q000627:therapeutic use*; D002985:Clinical Protocols; D003131:Combined Modality Therapy; D005078:Exchange Transfusion, Whole Blood; D005260:Female; D006319:Hearing Loss, Sensorineural / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D051556:Hyperbilirubinemia, Neonatal / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007155:Immunologic Factors / Q000627:therapeutic use*; D007231:Infant, Newborn; D007262:Infusions, Intravenous; D007564:Japan; D008297:Male; D010789:Phototherapy; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D000418:Albumins; D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors