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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. High bilirubin levels in neonates are known to be associated with kernicterus

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Neonatal Bilirubin Levels and Developmental Outcome

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  1. Neonatal Bilirubin Levels and Developmental Outcome Dennis Odell Rachel Duchoslav Erin Clark Rena Vanzo Lisa Samson-Fang

  2. 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

  3. 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

  4. 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?

  5. 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.

  6. 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

  7. 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

  8. 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

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