Analysis Of Etiology And Related Factors Of Severe Hyperbilirubinemia In Term Infants And Near-term Infants

Objectives:Retrospective investigation of the epidemiological characteristics of severe hyperbilirubinemia and bilirubin encephalopathy in newborns in our hospital over the past five years,exploration of their clinical characteristics and related diagnosis and treatment,analysis of risk factors for different degrees of severe hyperbilirubinemia;Provide valuable clinical reference information for the prevention and treatment of bilirubin encephalopathy.Method:A single center,retrospective study was conducted to include newborns diagnosed with severe hyperbilirubinemia and gestational age>35 weeks in the neonatal intensive care unit of the First Affiliated Hospital of Kunming Medical University from January 2018 to December 2022.The general information including birth history,feeding history,postnatal illness status,age at which severe hyperbilirubinemia occurred,peak bilirubin levels,cause of jaundice,treatment status,auxiliary examinations outcomes.And collect relevant maternal pregnancy history,including mother’s age,education level,conception method,number of pregnancies,pregnancy complications,prenatal conditions.The study was divided into four parts,1.The descriptive study was used to review and analyze the incidence rate of severe hyperbilirubinemia and acute bilirubin encephalopathy in term and near term infants in our hospital: the case-control study was used to divide the children into obstetric transfer group and non-obstetric transfer group according to their source,and analyze their clinical characteristics.2.Using a case-control study,children were classified as severe hyperbilirubinemia based on different peak bilirubin levels(342 μmol/L ≤serum total bilirubin(TSB)< 428 μmol/L),extremely severe hyperbilirubinemia(342 μmol/L ≤TSB<428 μmol/L),dangerous hyperbilirubinemia(TSB ≥ 513μmol/L),to explore the high-risk factors for severe hyperbilirubinemia of different degrees.3.A case-control study was conducted to investigate the correlation between head magnetic resonance imaging(MRI),brainstem auditory evoked potential(AABR),and clinical diagnosis.Use SPSS27.0 statistical software package for statistical analysis.Result:1.The incidence of severe hyperbilirubinemia and acute bilirubin encephalopathy in our hospital,from 2018 to 2022,the number of cases diagnosed with severe hyperbilirubinemia and their proportion to the number of discharged newborns in the same year were 166 cases(8.11%),157 cases(6.55%),94 cases(4.31%),57 cases(2.18%),and 67 cases(2.77%).The proportion of patients diagnosed with acute bilirubin encephalopathy at discharge to all newborns with hyperbilirubinemia in the same year was 4.47%,0.67%,0.34%,0.19%,and 0.53%.The overall incidence of severe hyperbilirubinemia and acute bilirubin encephalopathy is decreasing.2.Compared with the outpatient admission group,there was a statistically significant difference in weight loss of >10% between the obstetric admission group and the outpatient admission group(P<0.05).The number of patients with weight loss of >10% in the obstetric admission group was significantly higher than that in the outpatient admission group.The hospitalization days,duration of intense phototherapy,and total duration of phototherapy in the outpatient admission group were higher than those in the obstetric admission group(P<0.05).The peak TSB and serum albumin value at admission in the outpatient admission group were higher than those in the obstetric admission group(P<0.05).All patients diagnosed with acute bilirubin encephalopathy at discharge were from the outpatient admission group.3.In the past 5 years,among the children with severe hyperbilirubinemia admitted to our hospital who were diagnosed with acute bilirubin encephalopathy before discharge,66.1% were based on positive head MRI,10.2% were based on positive head MRI+AABR,1.7% were based on positive AABR,and 1.7% were based on abnormal NBNA scores.4.Correlation analysis of bilirubin peak,non-breastfeeding has a negative correlation with bilirubin peak(B<0,P<0.05),while hereditary glucose-6-phosphate dehydrogenase deficiency(G-6PD),periventricular hemorrhage,infection,and weight loss have a positive correlation with bilirubin peak(B>0,P<0.05).5.Analysis of influencing factors of different degrees of severe hyperbilirubinemia.Compared with the severe hyperbilirubinemia group,infection can increase the risk of extremely severe hyperbilirubinemia(OR=0.40,95% CI: 0.19-0.84,P<0.05)and dangerous hyperbilirubinemia(OR=6.38,95% CI: 1.20-33.84,P<0.05),G-6PD can also increase the risk of high-risk hyperbilirubinemia(OR=169.6,95% CI: 4.54-6331,P<0.05).6.Analysis of causes and adverse reactions of blood exchange.Among patients with severe hyperbilirubinemia in our hospital,the most common reasons for undergoing blood exchange therapy are intracranial hemorrhage,infection and homologous immune hemolysis,with some patients merging two or more causes.The most common adverse reactions after blood exchange in our hospital are thrombocytopenia(67.57%),anemia(64.86%),decreased albumin(29.73%),and hypokalemia(16.22%),with no serious adverse events such as death.Conclusion:1.Strengthening early monitoring after birth can effectively reduce the occurrence of severe hyperbilirubinemia and acute bilirubin encephalopathy.2.Infection can increase the risk of developing extremely severe and dangerous hyperbilirubinemia,while G-6PD can increase the risk of developing dangerous hyperbilirubinemia;Periventricular hemorrhage,infection,and weight loss increase the peak bilirubin levels,while non-exclusive breastfeeding reduces the peak bilirubin levels.3.The main causes of hyperbilirubinemia are intracranial hemorrhage,infection,and homologous immune hemolysis.The most common adverse reactions after blood exchange are thrombocytopenia,anemia,decreased albumin and hypokalemia.4.In recent five years,the incidence rate of severe hyperbilirubinemia in our hospital has significantly decreased,the overall completion rate of skull MRI is high,and the completion rate of AABR screening is poor.The diagnostic standardization of bilirubin encephalopathy is insufficient,and there is a lack of follow-up basis after discharge,which requires further strengthening of management.