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Neonatal Bilirubin Levels and Developmental Outcome. Dennis Odell Rachel Duchoslav Erin Clark Rena Vanzo Lisa Samson-Fang. Background. High bilirubin levels in neonates are known to be associated with kernicterus

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neonatal bilirubin levels and developmental outcome

Neonatal Bilirubin Levels and Developmental Outcome

Dennis Odell

Rachel Duchoslav

Erin Clark

Rena Vanzo

Lisa Samson-Fang

background
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
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
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
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
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
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
urlend 2010 2011
URLEND 2010-2011
  • Individual Leadership Project as a supplementary experience
    • Continue current group project format
    • Encourage identification of individual project opportunities during clinical rotations
      • Count toward clinical/research/leadership hours
      • Enrich the current URLEND experience
      • Facilitate the transition to leadership roles
      • Lead to projects with lasting community impact
      • Highlight URLEND capabilities