Analysis The Risk Factors Of Neonatal Bilirubin In Nerve Injury And The Value Of BAEP And MRI In Diagnosis Of Early Bilirubin Encephalopathy

Objective:The clinical data of children with hyperbilirubinemia and bilirubin encephalopathy were analyzed,and to evaluate the value of BAEP,MRI and BIND scores in the early stage of bilirubin-induced nerve damage.Methods:1.A retrospective study was performed on 561 neonates diagnosed with hyperbilirubinemia and improved brainstem auditory evoked potential(BAEP)in the Children's Hospital of Soochow University from January 2012 to December 2018.According to the BAEP,it was divided into the control group(363 cases in the normal BAEP group)and the experimental group(198 cases in the abnormal BAEP group).Recorded and compared the child's condition at birth,the condition of admission,the mother's pregnancy,laboratory indicators and other data,analyze the risk factors for bilirubin-induced neurological damage(BAEP abnormal results),and further understand the clinical characteristics of the auditory nerve injury in children;2.122 neonates who improved MRI and BAEP and diagnosed as neonatal hyperbilirubinemia were selected as the control group,and 80 children diagnosed as neonatal bilirubin encephalopathy in the Children's Hospital of Soochow University were included in the experimental group.The clinical data were collected to compare the diagnostic value of brainstem auditory evoked potential(BAEP)and skull MRI in bilirubin encephalopathy,and to evaluate the correlation between BIND score and auxiliary examination.Results:1.1.The bilirubin/albumin(B/A)ratio and total serum bilirubin(TSB)levels in the BAEP abnormal group were higher than those in the nonnal BAEP group(control group),the data of the two groups were statistically significant.(P<0.05);1.2.According to the bilirubin level,the abnormal rate of BAEP between the groups was different,and increased with the bilirubin level(P<0.05);1.3.The area under the receiver characteristic curve(ROC)of both TSB and B/A was 0.557 and 0.578,both of which were less than 0.7,and the accuracy was not high.1.4.BAEP abnormal group and BAEP normal group single factor comparison analysis:premature rupture of membranes,gestational age,umbilical cord abnormalities,pregnancy and gestational diabetes were significantly different between the two groups(P<0.05);1.5.According to the comparison of the above clinical data,the factors with obvious statistical differences were set as independent variables,and the BAEP results were used as dependent variables.Logistic multivariate regression analysis was further performed on the meaningful independent variables.The results showed:gestational age.gestational diabetes and premature rupture of membranes were the independent risk factors for BAEP abnormalities.2.1.The TSB level and B/A ratio in the bilirubin encephalopathy group were higher than those in the control group(neonatal hyperbilirubinemia group),and the difference was statistically significant(P<0.05).2.2 The abnormalities of brainstem auditory evoked potentials and MRI in the bilirubin encephalopathy group were 75.7%and 48.9%,both were higher than the BAEP abnormal rate(46.7%)and the MRI abnormal rate(2.45%)in the hyperbilirubinemia group,the difference was statistically significant(P<0.05).2.3.Using the ROC curve to analyze the significance of BAEP in the diagnosis of bilirubin encephalopathy.The results showed that:the sensitivity of BAEP was 75.7%,and the specificity of BAEP was 53.3%,the area under the ROC curve(AUC)was 0.638(P<0.05).2.4.Using the ROC curve to analyze the significance of skull MRI in the diagnosis of bilirubin encephalopathy,the results showed that the specificity of MRI was 97.5%,the sensitivity of MRI was 48.9%,and the area under the ROC curve(AUC)was 0.732(P<0.05).2.5.According to the different BIND scores,the abnormal rate of BAEP and MRI gradually increased with the score,and there was a certain correlation,but there was no statistical significance(P>0.05).Conclusions:1.The TSB and B/A values in the BAEP abnormal group were higher than those in the normal BAEP group,and the abnormal rate of BAEP was positively correlated with the bilirubin level of the children,but the sensitivity of both are not strong;2.BAEP is highly sensitive to hearing impairment in children with hyperbilirubinemia and can be used as an important means of detecting auditory nerve damage caused by bilirubin;3.Maternal gestational diabetes,premature rupture of membranes,gestational age is an independent risk factor for abnormal BAEP in children with hyperbilirubinemia.4.MRI and BAEP examination combined with BIND scores are important for the early diagnosis of bilirubin encephalopathy.