Preterm neonates often develop hyperbilirubemia leading to jaundice. Parents must understand that bilirubin is a neurotoxin which may damage brain cells.

1. Effects of Premature Birth on Neurocognitive Development and Academic
Performance: Longitudinal IEP Review of PT and SGA Student
Alamy, 2015; Beery, Buktenic , 2011; Woodcock-Johnson III Normative Update (NU) Complete
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2. Neonatal
Hyperbilirubemia and Jaundice
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Sherman, 2016
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3. Infants born with very low birth weight (≤ 1500 grams), neonatal hyperbilirubinemia, and
bronchopulmonary dysplasia experienced language delay at 3-years of age.
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Infants born with very low birth weight (≤ 1500
grams), neonatal hyperbilirubinemia, and
bronchopulmonary dysplasia experienced
language delay at 3-years of age.
(Amin, Prinzing, & Myers, 2009)
Birth Weight and Neonatal Complications are Associated with
Language Delays
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4. Bilirubin is Toxic to Brain Cells
Jaundice is defined as maximal indirect serum bilirubin greater than 10 mg/dL
(171 per m/L)
(Usher & McLean, 1969 in Taylor, 2004; Amin, 2004) Ozella Brundidge, 4/3/2017

5. 5
Phototherapy and Exchange Transfusion are
Recommended at a Lower Serum Total Blood (STB)
level. Bilirubin Neurotoxicity may Increase the Risk
of Developing Central Auditory System Damage
Borderline Premature Infants are at Especial Risk of Bilirubin Production-Conjugation Imbalance.
(Can, et al., 2015; Kaplan, Muraca, Vreman, Hammerman, Vilei,
Rubaltelli, & Stevenson, 2005; Kaplan, Bromiker, & Hammerman, 2014)
Borderline Premature Infants (35-36 weeks gestation) are at
Significant Risk of Producing Excess Bilirubin
Hyperbilirubinemia – an imbalance between bilirubin production and excretion out of the body.
Sawyer, 2015, Dec. 6
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6. Late Preterm (34-36 𝟔
𝟕 weeks) Infants
have a 2- to 5-Fold Increased
Risk of Developing
Hyperbilirubemia and Jaundice
(Can, Verim, Baser, & Inan, 2015; Baron, Erickson, Ahronovich, Baker, & Littman, 2011; Adams-Chapman,
2006 in Loftin, et al., 2010; Bhutani & Johnson, 2006 in 2010; Watchko & Maisels, 2003 in Morse, et al., 2009)
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Late Preterm (34-36 𝟔
𝟕 weeks) Infants have a 2- to 5-Fold Increased Risk of Developing
Hyperbilirubemia and Jaundice
Neonatal Hyperbilirubinemia has a Degenerative Effect on the Auditory System
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7. hyperbilirubinemia has a the neurotoxic effect on
the auditory pathway
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Hyperbilirubinemia has a Neurotoxic
Effect on the Auditory Pathway that
may lead to Auditory Neuropathy
Spectrum Disorder.
(Can, Verim, Baser, & Inan, 2015; Raveh et al, 2007 in 2015)
Inner Hair Cells Cochlear Cochlear Nerve Auditory Brainstem Primary Auditory Center
Bilirubin Values Varying from 7 to 25 mg/dl may Cause
Auditory Neuropathy/Auditory Dyssynchrony
*Can and colleagues assert that total serum bilirubin levels 20 mg/dl (mean 22.3 1.76 mg/dl) may cause AN/AD in 2% of late
preterms treated with phototherapy, and lower levels may be safe.
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8. Most Cases of Infantile Hyperbilirubinemia (60%) are
Physiological Conditions and Harmless
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(Rance, 2005 in Can, Verim, Baser, & Inan, 2015)
• Even Short-Term Increases in the Bilirubin Blood
Level can Induce Temporary or Permanent
Changes in Evoked Potentials.
• An Increase in Threshold and Wave Latency (I–V)
in Auditory Brainstem Responses (ABR) indicates
that both peripheral and central auditory systems
are sensitive to high bilirubin levels.
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9. Incomplete Maturation of the Bilirubin Conjugating Enzymes in Premature
Infants Increase Risk for Developing Hyperbilirubinemia
(Kaplan, Muraca, Vreman, Hammerman, Vilei, Rubaltelli, Stevenson, 2005; Dennery, 2001 in Kaplan, 2005; American
Academy of Pediatrics, Subcommittee on Neonatal Hyperbilirubinemia. Neonatal jaundice and kernicterus. Pediatrics
2001 in 2005; Morse, Zheng, Tang, & Roth, 2009; Watchko & Maisels, 2003 in Morse, et al., 2009)
Borderline prematurity was previously found to be an
important contributing factor to hyperbilirubinemia,
*UDP-glucuronosyltransferase 1A1 (UGT)
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placing these neonates at a high risk status for
developing jaundice.
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10. The Current Case Study Student was a High
Risk Neonate born with Complications
Resulting in Incubation Treatment for
Jaundice in the Neonatal Intensive Care Unit
(NICU).
(Case Study Student's (1998, June 3). Individual and family assessment outline-adoption – Part B, Section II. Individual and family
life areas-Background, A. Child to be adopted. Division of Family and Youth Services; Baron, Erickson, Ahronovich, Baker, &
Littman, 2011; Adams-Chapman, 2006 in Loftin, et al., 2010; Bhutani & Johnson, 2006 in 2010)
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Case Study Student was Born Small for Gestational (SGA) with Neonatal Complications Including
Incubation Treatment for Jaundice in a Neonatal Intensive Care Unit (NICU)
Hyperbilirubin Levels may Lead to Jaundice
(Sherman, 2016)
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11. Odds of Health Complications Decrease with Advancing Gestational
Age through the Late Preterm Period (34-36 𝟔
𝟕 weeks)
0
1
2
3
4
5
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Respiratory Distress Septis (Hyperbilirubin/Jaudice) Patent Ductus Arteriosus
Rate of Health Problems Associated with Late Preterm Deliveries by
Gestational Age
34 Weeks 35 Weeks 36 Weeks
Figure 1. Rate of respiratory distress, sepsis, and patent ductus arteriosus (PDA) by gestational age (Loftin, Habli, Snyder,
Cormier, Lewis, & DeFranco, 2010, p.14).
Percent(%)
(Current Case Study
Student had
Jaundice)
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12. End of Neonatal
Hyperbilirubemia/Jaundice
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