From the Guidelines
Phototherapy is not a direct risk factor for hearing loss in infants, as there is no conclusive evidence to support this association. The primary concern with phototherapy is the potential for bilirubin toxicity effects on the auditory system, but this is more related to the underlying condition of hyperbilirubinemia rather than the phototherapy itself 1. When infants undergo phototherapy for hyperbilirubinemia (jaundice), the treatment aims to reduce bilirubin levels and prevent neurotoxicity, including potential damage to the auditory nerve and brainstem auditory pathways.
Some key points to consider:
- The breakdown products of bilirubin during phototherapy might contribute to oxidative stress in sensitive auditory tissues, but this is not a direct cause of hearing loss 1.
- The noise generated by phototherapy equipment is not a significant concern for hearing loss, as the levels are relatively low (approximately 60-80 decibels) and not prolonged enough to cause acoustic trauma 1.
- Infants who undergo phototherapy should receive standard hearing screening before discharge, as part of routine newborn care, but this is not specifically due to the risk of phototherapy-induced hearing loss.
- Early detection of any hearing impairment is crucial for timely intervention to support normal language and cognitive development, but this is a general recommendation for all newborns, not specifically those who received phototherapy 1.
It is essential to note that the current evidence does not support a direct link between phototherapy and hearing loss in infants. The primary focus should be on managing hyperbilirubinemia and preventing bilirubin neurotoxicity, rather than attributing potential hearing loss to the phototherapy treatment itself 1.
From the Research
Phototherapy and Hearing Loss in Infants
- Phototherapy is a common treatment for neonatal jaundice, but it has been associated with an increased risk of hearing loss in infants 2.
- A study published in 2020 found that hearing impairment was significantly more frequent among newborns with total serum bilirubin (TSB) levels >23mg/dl who required phototherapy or exchange transfusion 2.
- The same study found that peak TSB level >23mg/dl can be predictive for the development of hearing impairment, with a sensitivity of 100% and specificity of 93% 2.
- Another study published in 2019 highlighted the potential side effects of phototherapy on neonates, including its effects on the immune and inflammatory system, and its potential genotoxic and late side effects 3.
- While the exact mechanism of how phototherapy contributes to hearing loss is not fully understood, it is thought that high levels of bilirubin can damage the auditory nerve and lead to hearing impairment 2.
Risk Factors for Hearing Loss
- High levels of total serum bilirubin (TSB) (>23mg/dl) have been identified as a risk factor for hearing loss in infants who require phototherapy or exchange transfusion 2.
- The use of phototherapy, particularly intensive phototherapy, has been shown to decrease the need for exchange transfusion, but its long-term effects on hearing are not well understood 4.
- Other factors, such as gestational age and the presence of other medical conditions, may also contribute to the risk of hearing loss in infants who receive phototherapy 2.
Long-term Effects of Phototherapy
- The long-term effects of phototherapy on infants are not well understood, but studies have suggested that it may be associated with an increased risk of melanocytic naevus formation and other skin conditions 5.
- A study published in 2013 highlighted the need for further research on the long-term effects of phototherapy, particularly in relation to its potential impact on hearing and other sensory development 5.
- The use of phototherapy should be carefully monitored and guided by clinical guidelines to minimize the risk of adverse effects, including hearing loss 6, 3.