| Objective: Neonatal hyperbilirubinemia is very common in neonatal diseases and may cause organ damage due to severe jaundice.This study aimed to the assessment of cardiac indicators of newborns with hyperbilirubinemia to investigate the characteristics of myocardial injury about neonates with hyperbilirubinemia,and the changes in assistant examination.Meanwhile,to discuss the correlation between serum total bilirubin and the data of examination of myocardial injury with neonatal heart injury.Methods:In the Fifth People’s Hospital of Chengdu,From January 2016 to January 2017,82 cases of full-term newborns diagnosed as neonatal hyperbilirubinemia with gestational age of 37 to 40 weeks,with no history of asphyxia and severe congenital heart,lung,liver,kidney and other diseases,were selected as the study group,and the study group was divided into three groups according to the degree of jaundice 35 cases of mild jaundice(TBIL 221 ~ 255?μmol/L),27 cases of moderate jaundice(256 ~ 341μmol / L)and 20 cases of severe jaundice(≥342 μmol / L).At the same time,30 healthy full-term newborns born in the same period of obstetrics as control group.All of the newborns enrolled in the study were completed the examination of serum bilirubin(TBIL,IBIL),electrocardiogram,myocardial injury markers(CK-MB,cTnT),echocardiography,and 24 hour dynamic electrocardiogram.To compare the data between the healthy newborns and neonates with different levels of jaundice.To analyze the correlation between serum total bilirubin and the data of examination with neonatal heart injury.Results: 1.Myocardial injury markers: severe jaundice group,moderate jaundice group,mild jaundice group and control group CK-MB were(299.27 ± 79.54),(235.38 ± 80.89),(199.73 ± 51.73)and(104.22 ± 36.24)U/L,the markers of severe jaundice group was higher than the that of moderate jaundice group,mild jaundice group and control group(t = 3.475,5.698 and 10.843,respectively,all P <0.05).cTnT were(0.16 ± 0.05),(0.12 ± 0.03),(0.11 ± 0.02)and(0.07 ± 0.03)ng/ml among the four groups,cTnT in the severe jaundice group was higher than that in the moderate jaundice group,mild jaundice group and the control group(t= 3.905,5.929 and 9.667 respectively,P <0.05).2.ECG: 4 cases(4.87%,4/82)showed abnormal ECG.3.Echocardiography: Doppler ultrasonography showed that the ejection fraction(EF)in severe jaundice group,moderate jaundice group,mild jaundice group and control group were(69.45 ± 3.05),(70.65 ± 2.71),71.36 ± 3.16)and(72.03 ± 2.48)%,EF in the severe jaundice group was lower than in the moderate jaundice group,mild jaundice group and the control group(t = 2.012,2.376 and 3.121 respectively,P < 0.05),there was no statistically significant difference among the other three groups.The shortening fraction(FS)of the four groups were(36.95 ± 1.69),(38.50 ± 1.80),(39.02 ± 2.24)and(39.17 ± 3.20)%,FS in the severe jaundice group was lower than that in the moderate jaundice group,mild jaundice group and the control group(t = 2.212,3.113 and 3.234,respectively,all P <0.05).There was no significant difference among the other three groups.The peak early filling velocity(E)were(6.08 ± 0.29),(6.40 ± 0.26),(6.44 ± 0.39)and(6.46 ± 0.55)cm/s,E in the severe jaundice group was lower than that in the moderate jaundice group,mild jaundice group and the control group(t = 2.687,3.122 and 3.079 respectively,P <0.05).There was no significant difference among the other three groups.The atrial contraction velocity(A)in the four groups were(6.21 ± 0.19),(5.89 ± 0.25),(5.88 ± 0.28)and(5.88 ± 0.34)cm/s,A in the severe jaundice group was higher than that in the moderate jaundice group,mild jaundice group and the control group(t =3.821,4.197 and 4.463,respectively,all P <0.05).There was no significant difference among the other three groups.The E / A ratio among the four groups were(0.96 ± 0.09),(1.08 ± 0.12),(1.11 ± 0.85)and(1.11 ± 0.14),the E/A in the severe jaundice group was lower than that in the moderate jaundice group,mild jaundice group and the control group(t = 3.539,4.803 and 4.441 respectively,all P <0.05).There was no significant difference among the other three groups.4.Timedomain analysis of heart rate variability index: SDNN in severe jaundice group,moderate jaundice group,mild jaundice group and control group were(52.79 ± 2.63),(57.46 ± 3.92),(60.38 ± 4.40)and(61.52 ± 4.36)ms,SDNN in severe jaundice group was lower than that in moderate jaundice group,mild jaundice group and control group(t = 3.948,6.747 and7.538 respectively,P <0.05),SDNN in moderate jaundice group was lower than that in mild jaundice group and control group(t = 2.836 and 3.813,respectively,P <0.05).There was no significant difference among the other three groups.The SDANN of the four groups were(38.43 ± 2.25),(40.37 ± 1.91),(42.62 ± 4.37)and(43.60 ± 3.09)ms,SDANN in the severe jaundice group was lower than that in the moderate jaundice group,mild jaundice group and the control group(t = 2.856,4.198 and 5.496 respectively,P <0.05),SDANN in the moderate jaundice group was lower than that in mild jaundice group and the control group(t = 2.722 and 4.173 respectively,P <0.05).There was no significant difference between the other two groups.The r MSSD were(14.45 ± 2.64),(19.20 ± 4.95),(18.71 ± 3.77)and(19.02 ± 4.93)ms,rMSSD in the severe jaundice group was lower than that in the moderate jaundice group,mild jaundice group and the control group(t = 3.784,3.568 and 3.713,P <0.05).There was no significant difference among the other three groups.The PNN50 were(1.30 ± 0.30),(1.81 ± 0.29),(1.79 ± 0.38)and(1.84 ± 0.41)%,PNN50 in the severe jaundice group was lower than that in the moderate jaundice group,mild jaundice group and the control group(t = 4.868,4.890 and 5.264,P <0.05).There was no significant difference among the other three groups.5.Neonates with myocardial injury,the cTnT in neonates with hyperbilirubinemia was positively correlated with TBIL(correlation coefficient: 0.603,P = 0.001,<0.05),while there was no significant correlation between CKMB and TBIL(P = 0.296,> 0.05).Echocardiography EF,FS,E / A and TBIL were negatively correlated(correlation coefficient-0.682,-0.498,-0.626,respectively,all P<0.05);A index was positively correlated with TBIL(correlation coefficient 0.632,P <0.05).No correlation was found between E index and TBIL(P> 0.05).SDNN and PNN50 with TBIL were negatively correlated(correlation coefficients-0.514,-0.700,respectively,P <0.05),while SDANN and rMSSD with TBIL were not related(P> 0.05).Conclusion :Hyperbilirubinemia could lead to neonatal myocardial damage;hyperbilirubinemia neonatal ECG had low positive rate and less sensitive.There was a correlation between the levels of cTnT,EF,FS,A,E/A,SDNN,PNN50 and TBIL in hyperbilirubinemia neonatal with myocardial injury.These indexes could be used to evaluate the cardiac function in hyperbilirubinemia neonatal with myocardial injury. |
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