Hyperbilirubinemia Requiring Exchange Transfusion as a Risk Factor for Later-Onset Hearing Loss.

Background: Previous position statements by the Joint Committee on Infant Hearing (JCIH) have recommended the presence of hyperbilirubinemia requiring exchange transfusion as a risk factor for childhood hearing loss. This article examines the strength of the evidence to support this recommendation.

Methods: A PubMed^® query using the keywords hyperbilirubinemia and hearing loss identified 77 original papers. All abstracts were reviewed for consideration of full article review and 44 articles were reviewed for consideration of inclusion and grading, with 21 articles graded using structured evidence-grading forms. Nineteen articles were included to provide supporting rationale for recommendations. Evidence grading was completed by recommendation.

Results: A moderate level of evidence supports hyperbilirubinemia requiring exchange transfusion as a risk factor for elevated hearing thresholds among infants and young children. It is recommended to employ Automated Auditory Brainstem Response screening in this population of infants. These recommendations are based on the findings across multiple graded studies where the net benefit is moderate or substantial. Intervals for on-going monitoring of hearing previously recommended by JCIH are supported by expert consensus.

Conclusion: If an infant with hyperbilirubinemia requiring exchange transfusion passes the newborn hearing screening, close monitoring of hearing, speech, and language milestones are important and should lead to improved outcomes for the child.