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W. V. Good, C. Hou, A. M. Norcia; Neonatal Jaundice and Vision Loss. Invest. Ophthalmol. Vis. Sci. 2010;51(13):133.
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Neonatal jaundice is common in infants and is caused by elevated levels of bilirubin. Bilirubin that crosses the blood brain barrier (indirect, or "free bilirubin") is neurotoxic in high doses. Despite the low incidence of kernicterus (permanent neurological damage caused by hyperbilirubinemia), more subtle effects of lower levels of bilirubin on the developing neurological system are possible and debated.
We examined 16 infants at 3 - 5 months of age who had been born full term and were clinically jaundiced. These infants had a bilirubin level measured before day 3 of life and their bilirubin levels ranged from 7 to 25 mg/dL. The examination consisted of a measure of sweep VEP (sVEP) response curves as a function of spatial frequency at high contrast (to measure grating acuity), as a function of contrast at a low spatial frequency (to measure maximal contrast sensitivity) and as a function of vernier offset size (to measure position acuity). These 16 infants were compared to 18 age-matched full term infants with no history of jaundice or treatment for jaundice. Response amplitudes were measured and thresholds were estimated by extrapolation of the VEP response function to zero amplitude. Threshold comparisons were made with healthy, full term, age-matched infants. Signal amplitude comparisons were also made with these age-matched control infants.
Control infants show greater signal amplitudes compared to infants who had hyperbilirubinemia. The finding exists for all vision functions (grating, contrast, and vernier sensitivity), and is most pronounced for contrast sweeps where it is seen across the entire range of contrasts tested. Furthermore, a correlation exists between the peak serum bilirubin level shortly after birth, and the vernier acuity threshold measured at 3 - 5 months of age suggesting that neuronal sensitivity could also be influenced by an experience with neonatal jaundice.
Neonatal jaundice has a deleterious effect on VEP amplitudes for contrast, spatial frequency and vernier offset sweeps. The finding persists to at least 3 - 5 months of age. Neuronal sensitivity (acuity threshold) is also affected at 3 - 5 months of age for vernier offsets.
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