Am J Perinatol
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

Yair Kasirer*
1  Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel
2  Department of Pediatrics, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
,
Alona Bin-Nun*
1  Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel
2  Department of Pediatrics, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
,
1  Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel
2  Department of Pediatrics, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
,
Ortal B. Yosef
2  Department of Pediatrics, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
,
Neelan Marianayagam
3  Department of Neurological Surgery, Weill Cornell Medical Center – New York Presbyterian Hospital, New York, New York
,
Aliza Hammerman-Rozenberg
1  Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel
,
Irina Shchors
1  Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel
,
Eliel Ben-David
2  Department of Pediatrics, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
4  Department of Radiology, Shaare Zedek Medical Center, Jerusalem, Israel
› Author Affiliations

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.

Financial Disclosure

The images used in this study were acquired from MRI scans that were funded by Aspect Imaging LTD for another study. The sponsor had no further involvement in the current study. Data collection, analysis and interpretation, writing, and submitting the manuscript for publication were made by the authors. No honorarium, grant, or other forms of payment were given to anyone to produce the manuscript. The authors have no financial relationships relevant to this article to disclose.


Registration

This trial was registered with the Israel Ministry of Health, no.: MOH_2017–08–31_000339.


Authors' Contributions

A.B.N. conceptualized and designed the study and supervised data acquisition and reviewed the manuscript for intellectual content.


C.F. conceptualized the study, coordinated and supervised data acquisition, drafted the initial manuscript, and reviewed and revised the manuscript.


A.H.-R. performed the initial data analysis and provided statistical consultation and reviewed the manuscript for intellectual content.


O.B.Y., N.M., and E.B.D. conceptualized and designed the MRI aspects of the study, MRI data acquisition and implemented the MRI analyses, and reviewed the manuscript for intellectual content.


Y.K. and I.S. assisted in clinical data acquisition and interpretation.


All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.


* These authors contributed equally to this work as first authors.




Publication History

Received: 06 July 2021

Accepted: 13 September 2021

Publication Date:
20 September 2021 (online)

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