ABSTRAK
Fragmen bilirubin yang tidak terkonjugasi dan tidak terikat albumin (bilirubinbebas) pada neonatus dapat menembus sawar darah otak sehingga terjadikerusakan otak berupa ensefalopati bilirubin akut. Salah satu gejala ensefalopatibilirubin akut adalah tuli sensorineural. Penelitian sebelumnya menunjukkanbahwa bilirubin bebas mempunyai neurotoksisitas lebih besar dibandingkandengan bilirubin total, namun pemeriksaan bilirubin bebas lebih sulit, rumit,mahal dan belum tersedia di klinik; sehingga perlu dicari pemeriksaan lain yanglebih praktis dan aplikatif. Salah satu pilihan untuk menentukan neurotoksisitasbilirubin adalah pengukuran rasio bilirubin total terhadap albumin (BT/A).Penelitian ini merupakan penelitian potong lintang berulang, bersifatobservasional, longitudinal, dan prospektif berupa uji diagnostik untukmengetahui proporsi tuli sensorineural yang diprediksi berdasarkan nilai rasioBT/A tertentu pada neonatus BBLR dengan hiperbilirubinemia. Penelitian inidilakukan dalam periode bulan Agustus 2015 sampai dengan Maret 2016, dengandua tahap pemeriksaan OAE dan BERA. Pemeriksaan pertama sebagai skriningpendengaran dilakukan saat subjek berumur ≥ 7β jam?1 minggu dan pemeriksaankedua/diagnostik pada usia 3?6 bulan.Dari 131 subjek yang dilakukan skrining pendengaran dengan OAE dan BERA,terdapat 70 subjek dengan hasil refer dan 61 dengan hasil pass. Lima puluh satusubjek datang pada pemeriksaan kedua/diagnostik (response rate 38,9%). Hasilpemeriksaan diagnostik adalah 9 subjek tuli sensorineural (6,87%) yang terdiridari 5 subjek tuli sensorineural bilateral, 2 subjek tuli sensorineural unilateral dan2 subjek neuropati auditorik. Rasio BT/A berperan terhadap terjadinya tulisensorineural dengan OR 16, p = 0,003, sensitivitas 89% dan spesifisitas 67%.Pada penelitian ini juga didapatkan angka rujukan bilirubin total dan rasio BT/Ayang dapat menyebabkan tuli sensorineural pada neonatus BBLRhiperbilirubinemia yaitu 12,21 mg/dL dan 0,46.Rasio BT/A dapat digunakan sebagai prediktor tuli sensorineural pada neonatusBBLR dengan hiperbilirubinemia.

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ABSTRACT
In neonates, unconjugated unbound bilirubin (free bilirubin) can penetrate theblood brain barrier, causing brain damage in the form of acute bilirubinencephalopathy as one of the symptoms is sensorineural hearing loss. Previousresearch has demonstrated that free bilirubin neurotoxicity was more sensitivethan total bilirubin, but the free bilirubin test is more difficult, complicated,expensive and not available in the clinic; thus it is necessary to find other testswhich is more practical and applicable. One of the option to determine thebilirubin neurotoxicity is a measurement of the ratio of total bilirubin to albumin(BT/A).This is a repeated cross sectional study done in observational, longitudinal andprospective diagnostic tests to determine the proportion of sensorineural hearingloss predicted based on the value BT/A ratio in low birth weight (LBW) neonateswith hyperbilirubinemia. The study was conducted from August 2015 until March2016, with two-stage examination of the OAE and BERA, i.e. ≥ 7β hours?1 weekand age of 3?6 months respectively.One hundred and thirty one subjects underwent hearing screening, and it revealedthat 70 subjects diagnosed as refer and the rest (61 subjects) was pass. During thesecond examination/diagnostics with response rate at 38.9%, 9 from 51 subjectswere diagnosed as sensorineural hearing loss (6.87%), i.e. five subjects withbilateral sensorineural hearing loss, two subjects with unilateral sensorineuralhearing loss and two subjects with auditory neuropathy. The BT/A ratiocontributes to the occurrence of sensorineural hearing loss with OR 16, p = 0.003,sensitivity 89% and specificity 67%. It also revealed in this study that thereference figure of bilirubin total and BT/A ratio were 12.21 mg/dL and 0.46respectively. Those reference value can be used to predict sensorineural hearingloss in LBW neonatal with hyperbilirubinemia.Ratio of BT/A can be used as a predictor of sensorineural hearing loss in LBWneonates with hyperbilirubinemia.