The Risk Factors Of Bilirubin-induced Neurotoxicity And Detection Of Unconjugated Bilirubin In Cerebrospinal Fluid In Full-term Newborns Of Severe Hyperbilirubinemia

Objective: To study the factor of acute bilirubin encephalopathy in full-term newborns with severe hyperbilirubinemia and the change of unconjugated bilirubin in cerebrospinal fluid in full-term newborns with acute bilirubin encephalopathy.Method A total of 149 cases of full-term newborns with severe hyperbilirubinemia from September 2013 to June 2014 were studied. They were divided into abnormal ABR(auditory brainstem response)group and normal ABR group according to ABR test results.Clinical datas and laboratory test results were also investigated.The datas of the two groups were compared using single factor analysis to filter out the related factors.Then the risk factors were analyzed using multi-factor analysis. The levels of the unconjugated bilirubin(UCB) in cerebrospinal fluid(CSF) and clinical datas between the two groups were also compared. SPSS18.0 software package was used for the statistical analysis. alpha=0.05 as a significant test standard.Result The univariate analysis showed:the occurrence of ABE was associated with neonatal sepsis, birth weight, gestational age and the levels of UCB in CSF;non conditional Logistic regression model multivariate analysis showed:the neonatal sepsis(OR= 8.138, 95% CI:1.165 ~56.835),the UCB(OR=1.270, 95%CI:1.092 ~1.478) was the independent risk factor of the infants with severe hyperbilirubinemia to happen the ABE;the gestational age(OR=0.357, 95%, CI:0.149 ~ 0.854) was the protective factor for the baby with severe hyperbilirubinemia to get the ABE;the level of UCB in CSF of ABE group and control group were 9.98 ±5.83?mol/L, 5.24±4.49?mol/L,there was significant difference between two groups(P=0.001);after contrilling other factors,the covariance analysis showed that the level of UCB in two groups were 10.297±1.342?mol/l,5.163±0.564 ?mol/L? The mean difference of the UCB in the CSF between two group was 5.134?mol/L,P=0.002.).Conclusion ABR could be used as the early diagnosis in full-term newborns with ABE.Small gestational age,the coexistence of neonatal sepsis and heigh level of UCB in the CSF were the risk factors of ABE in full-term newborns with severe hyperbilirubinemia.To early identify the occurrence of ABE,the examination of ABR should be carried out as early as possible in the full-term newborns with severe hyperbilirubinemia. The measurement of UCB in cerebrospinal fluid would be used as a sensitive indicator of the ABE.