654 - Association of Unconjugated Hyperbilirubinemia with Developmental Defects of Enamel in Primary Dentition of Children born at 24-32 Weeks’ Gestational Age.

Publication Number: 654.3875

Sanjiv B. Amin, Chidren's Hospital of Michigan, Pittsford, NY, United States

Background: Bilirubin exposure is known to adversely affect amelogenesis. Developmental Defects of Enamel (DDE) in primary dentition is a known manifestation of Kernicterus in term infants. However, the association of unconjugated hyperbilirubinemia, as indexed by peak total serum bilirubin (TSB) and peak unbound bilirubin (UB), with DDE in primary dentition of children born prematurely has not been well studied.

Objective: To evaluate the association between unconjugated hyperbilirubinemia and DDE in primary dentition of children born ≤ 32 wks' gestational age (GA).

Design/Methods: A prospective longitudinal study was performed including ≤ 32 wks' GA infants who were admitted to the NICU within 12 hours after birth. Infants with TORCH infections, chromosomal disorders, craniofacial anomalies, inherited anomalies of teeth, organic acidemia, moribund condition or who died were excluded. TSB and UB were measured twice daily, at least 8 hours apart, during the first postnatal week and thereafter if clinically indicated. TSB and UB were measured by colorimetric method and modified peroxidase method, respectively. DDE was assessed using the modified DDE index at 3 yrs of corrected age.

Results: A total of 183 infants were studied of whom 77 (42%) infants developed DDE in primary dentition. On bivariate analysis, there were no differences in maternal age, gravida, race, ethnicity, maternal marital status, maternal diabetes, chorioamnionitis, maternal drug usage, antenatal steroids, antenatal magnesium sulfate, mode of delivery, Apgar score ≤ 5 at 5 min, sex, birth weight, sepsis, patent ductus arteriosus, days on unfortified breast milk, days on parenteral nutrition, necrotizing enterocolitis, chronic lung disease, days on caffeine, or use of postnatal steroids between children with and without DDE. There were differences in GA, maternal preeclampsia, respiratory distress syndrome, days on mechanical ventilation, and days on furosemide between children with and without DDE (Table 1). On logistic regression, peak TSB was not associated with DDE (Adjusted OR 0.99, 95% CI:0.78-1.26) after controlling for GA, maternal preeclampsia, respiratory distress syndrome, days on mechanical ventilation, and days on furosemide. Also, peak UB was not associated with DDE (Adjusted OR 1.01, 95% CI:0.98-1.04) after controlling for confounders.

Conclusion(s): Unconjugated hyperbilirubinemia, as indexed by peak TSB and peak UB, is not associated with DDE in primary dentition of children born at 24-32 weeks GA. Duration of exposure to hyperbilirubinemia may play a role and needs to be investigated for its association with DDE in premature infants.

Table 1. Neonatal Clinical Characteristics and Developmental Defects of Enamel at 3 Years in Primary Dentition of Premature Infants
Table 1. Bilirubinemia and DDE PAS 2025.pdf