Neonatal Bilirubin Levels and

Developmental Outcome

Dennis OdellRachel Duchoslav

Erin ClarkRena Vanzo

Lisa Samson-Fang

Background High bilirubin levels in neonates are known

to be associated with kernicterus Multiple additional risk factors with high

bilirubin levels increase risk of kernicterus Tip of the iceberg?

Increased risk of autism/ADHD/LD with high bilirubin levels

Protocols are in place for measuring levels in all newborns

Controversies What is a safe bilirubin level??

Very poor predictive validity Natural biological mechanisms in place

that keep bilirubin levels high Do current treatments (phototherapy)

actually prevents adverse outcomes? Best best protocol to prevent kernicterus

is uncertain All newborns are screened to prevent very rare

cases

Research Questions Is there increased risk of autism/ADHD/LD with

high neonatal bilirubin levels? Are there identifiable risk factors that increase

the possibility of adverse outcomes? Do current treatment regimens such as

phototherapy decrease the risk of adverse outcomes?

Is bilirubin level over time a better predictor of outcome?

Is there any evidence of a protective effect of hyperbilirubinemia in neonates?

Methods-pilot study Identify children at USU clinic with a diagnosis of

autism/ADHD/LD Identify age/gender/ethnicity-matched healthy

controls through the Budge Clinic (pediatrics) Review clinic records, 0-3 developmental records,

and IHC intermountain records and record on chart review form

Statistical analysis of data, particularly looking at bilirubin levels and developmental outcomes, as well as presence or absence of identifiable risk factors.

Progress Assembled team to do study, and developed

research plan Developed chart review form and patient

identification protection protocols Contacted different sites to determine

accessibility of resources Submitted proposal to IHC and USU IRBs IRB approval obtained from both. Consent forms (letter of information, opt out

option)/protocols in place Ready to proceed with data acquisition and

analysis

Future plans Begin with 50-100 subjects and controls and

complete data acquisition Analyze data Based on pilot data, consider large scale study

utilizing IHC’s extensive database Consider multiple other related questions, such

as: association with hearing loss other developmental outcomes improving accuracy of current protocols to prevent

adverse outcomes

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