发育中的听觉系统作为胆红素神经毒性的窗口

文献信息

中文摘要

背景： 新生儿高胆红素血症是婴儿期最常见的疾病之一，也是全球范围内可预防的神经发育损伤的原因。听觉损伤是胆红素神经毒性众所周知的后果，其影响范围从严重病例中的听力损失到轻度至中度暴露时更细微的加工问题。若干细胞机制可以揭示这些损伤如何产生，以及生理功能障碍在永久性损伤之前何时可能可逆。当前的临床工具提供了关于胆红素引起的与听阈相关变化的极好信息。该领域的新兴方法，包括频率跟随反应（FFR），是有前景的候选方法，可用于纳入更细微的、阈上听觉加工测量。我们的工作表明，尽管常规测量在正常范围内，FFR仍反映中度高胆红素血症新生儿的缺陷，并随着治疗使胆红素水平改善而回升。未来需要研究以更好地描述听觉缺陷的模式，确定何时测试最具信息量，并确定新兴测量能在多大程度上预测后来的发育结局。

英文摘要

Neonatal hyperbilirubinemia is one of the most common conditions in infancy and a cause of potentially preventable neurodevelopmental injury worldwide. Auditory impairment is a well-known consequence of bilirubin neurotoxicity, with effects ranging from hearing loss in severe cases to more subtle processing problems with mild to moderate exposure. Several cellular mechanisms can shed light on how these impairments arise and when physiological dysfunction might be reversible before permanent injury. Current clinical tools provide excellent information about bilirubin-induced changes related to hearing thresholds. Emerging methods in this field, including the frequency-following response (FFR), are promising candidates to include more subtle, suprathreshold measures of auditory processing. Our work has shown that the FFR reflects deficits in neonates with moderate hyperbilirubinemia despite conventional measures within normal limits, and rebounds as bilirubin levels improve with treatment. Future studies are needed to better characterize the pattern of auditory deficits, determine when testing is most informative, and establish the extent to which emerging measures can predict later developmental outcomes.