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  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  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  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  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  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  Begin with 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

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