title: Unbound Bilirubin and Auditory Neuropathy Spectrum Disorder in Late Preterm and Term Infants with Severe Jaundice.
abstract: OBJECTIVE
  This study evaluates whether unbound bilirubin is a better predictor of auditory neuropathy spectrum disorder (ANSD) than total serum bilirubin (TSB) or the bilirubin:albumin molar ratio (BAMR) in late preterm and term neonates with severe jaundice (TSB ≥20 mg/dL or TSB that met exchange transfusion criteria).
  
  
  METHODS
  Infants ≥34 weeks' gestation with severe jaundice during the first 2 weeks of life were eligible for the prospective observational study. A comprehensive auditory evaluation was performed within 72 hours of peak TSB. ANSD was defined as absent or abnormal auditory brainstem evoked response waveform morphology at 80-decibel click intensity in the presence of normal outer hair cell function. TSB, serum albumin, and unbound bilirubin were measured using the colorimetric, bromocresol green, and modified peroxidase method, respectively.
  
  
  RESULTS
  Five of 44 infants developed ANSD. By logistic regression, peak unbound bilirubin but not peak TSB or peak BAMR was associated with ANSD (OR, 4.6; 95% CI, 1.6-13.5; P = .002). On comparing receiver operating characteristic curves, the area under the curve for unbound bilirubin (0.92) was significantly greater (P = .04) compared with the area under the curve for TSB (0.50) or BAMR (0.62).
  
  
  CONCLUSIONS
  Unbound bilirubin is a more sensitive and specific predictor of ANSD than TSB or BAMR in late preterm and term infants with severe jaundice.
authors.affiliation: Department of Pediatrics and Division of Neonatology, University of Rochester, Rochester, NY. Electronic address: Sanjiv_Amin@urmc.rochester.edu.
authors.forename: Sanjiv B
authors.initials: SB
authors.lastname: Amin
authors.affiliation: Department of Biostatistics, University of Rochester, Rochester, NY.
authors.forename: Hongyue
authors.initials: H
authors.lastname: Wang
authors.affiliation: Department of Pediatrics and Division of Neonatology, University of Rochester, Rochester, NY.
authors.forename: Nirupama
authors.initials: N
authors.lastname: Laroia
authors.affiliation: Department of Otolaryngology and Division of Audiology, University of Rochester, Rochester, NY.
authors.forename: Mark
authors.initials: M
authors.lastname: Orlando
mesh_terms: D001299:Audiometry; D001663:Bilirubin / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D016057:Evoked Potentials, Auditory, Brain Stem; D005260:Female; D006313:Hearing Loss, Central / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007567:Jaundice, Neonatal / Q000097:blood* / Q000150:complications*; D008297:Male; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D012709:Serum Albumin / Q000032:analysis; D047929:Term Birth
chemical_list: D015415:Biomarkers; D012709:Serum Albumin; D001663:Bilirubin
keywords: Total serum bilirubin; bilirubin-induced neurotoxicity; bilirubin:albumin molar ratio; sensitivity; specificity