Mildly Elevated Bilirubin Levels are Associated with Increased Magnetic Resonance Imaging Signal Intensity in the Basal Ganglia of Preterm Neonates

Yair Kasirer; Alona Bin-Nun; Cathy Hammerman; Ortal B. Yosef; Neelan Marianayagam; Aliza Hammerman-Rozenberg; Irina Shchors; Eliel Ben-David

doi:10.1055/a-1649-1918

American Journal of Perinatology, Table of Contents

Am J Perinatol 2023; 40(13): 1467-1472
DOI: 10.1055/a-1649-1918

Original Article

Mildly Elevated Bilirubin Levels are Associated with Increased Magnetic Resonance Imaging Signal Intensity in the Basal Ganglia of Preterm Neonates

Authors

Yair Kasirer ^*

¹Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel

²Department of Pediatrics, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
Alona Bin-Nun^*

¹Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel

²Department of Pediatrics, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
Cathy Hammerman

¹Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel

²Department of Pediatrics, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
Ortal B. Yosef

²Department of Pediatrics, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
Neelan Marianayagam

³Department of Neurological Surgery, Weill Cornell Medical Center – New York Presbyterian Hospital, New York, New York
Aliza Hammerman-Rozenberg

¹Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel
Irina Shchors

¹Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel
Eliel Ben-David

²Department of Pediatrics, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel

⁴Department of Radiology, Shaare Zedek Medical Center, Jerusalem, Israel

Abstract

Objective This study aimed to test whether mildly elevated bilirubin levels in preterm infants are associated with increased signal intensity (SI) on magnetic resonance imaging (MRI) of the basal ganglia (BG).

Study Design MRI was performed at term equivalent age in 55 postpreterm infants using a neonatal MRI 1-T scanner. SI of the BG was correlated with mild hyperbilirubinemia.

Results BG MRI SI was significantly increased in infants with mild hyperbilirubinemia on T1-weighted image (T1; p = 0.0393) and T2-weighted image (T2; p = 0.0309). We found no effect of gestational age or sepsis on BG MRI intensity; however, there was a significant effect of acidosis on T1 (p = 0.0223) but not on T2 (p = 0.2316). Infants with combined hyperbilirubinemia and acidosis had the most significant increase in SI on both T1 and T2 respectively (p = 0.0072 and 0.0195, respectively).

Conclusion We found a positive association between increased BG MRI SI and mildly elevated bilirubin levels. The effect was greatly strengthened when hyperbilirubinemia was associated with acidosis.

Key Points

Excessive bilirubin is neurotoxic to the neonatal brain. It is deposited in the BG.
BG MRI SI is increased with bilirubin deposition.
The premature brain is more vulnerable to bilirubin associated MRI changes.

Keywords

bilirubin - MRI - basal ganglia - preterm neonates

Full Text

References

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