| Objectives To explore the value of head MRI abnormalities in diagnosis and prognosis of bilirubin encephalopathy and provide a objective basic for children with high bilirubin prognosis.We have a retrospective analysis between the follow-up result on BE newborn(gestational age 35 weeks,or TSB 342 mu mol/L)nervous system development with early head MRI abnormalities.As we know Bilirubin neurotoxicity was dependent on dosages and time.So Neurologic symptoms has the characteristics of the progressive development,which can lead to the central nervous system's(ire)reversible cell damage or even death.clinical symptoms was Atypical.extending the time of the nerve cells exposed to toxic bilirubin,Causing the deposit of bilirubin in the nervous system.which leads to irreversible brain damage.corresponding appears the symptom of typical bilirubin encephalopathy eventually,This suggests that early judgment and timely intervention can prevent the occurrence and development of brain damage.bilirubin encephalopathy's diagnosis based on high blood bilirubin symptom and typical clinical manifestations of nervous system in the past.But With the development of iconography and the research on the mechanism of bilirubin encephalopathy,head MRI is become one of the early diagnosis method of bilirubin encephalopathy now.Which have a great significance to the health and growth of newborn.Subject and methods 1.Subjects The research object contains 103 hyperbilirubinemia cases which were treatment by Children's Hospital of Shanghai during September 2013 to January 2015.But eliminating some cases with inherited metabolic diseases,serve infection,history of suffocation,incomplete follow up and so on.There are 66 cases was researched finally.The Statistical data contain children's information(gestational age,hospital days of age,high risk factors,jaundice duration,feeding patterns,the degree of weight loss,the presence of acidosis,treatment),laboratory examination and head iconography changes.2.Diagnosis criteria of hyper bilirubinemia and bilirubin encephalopathy Diagnostic references the standard established by Chinese Academy of Pediatrics branch newborn study group in 2014.(1)adopting neonatalbilirubin monogram(Table 1)made by Bhutani etc in USA or phototherapy reference curve(Table 2)recommended by APP for newborns more than 35 weeks.(2)Severe hyperbilirubinemia: TBS peak was more than 342?mol/L(20 mg/d1),Extreme hyperbilirubinemia: TBS peak was more than 427?mol/L(25 mg/d1),Dangerous hyperbilirubinemia: TSB peak was more than 510?mol/L(30 mg/d1).(3)Bilirubin encephalopathy diagnosis mainly based on hyperbilirubinemia.Which includes the following features : TSB>342?mol/L(20mg/dl),rise speed >8.5?mol/L(0.5mg/dl),typical clinical manifestations of nervous system(Early hypotonic decrease,sleepiness,scream,cry and so on,late brothers move,eyeball movement disorder,hearing impairment,enamel hyperplasia),Cranial MRI(Acute basal ganglia hyper-intense globes T1 WI and T2WI)and BAEP for neonates with more than 35 weeks can be used as assist diagnosis.(4)Bilirubin encephalopathy contains four clinical types : classic nuclear jaundice,duskiness primarily nuclear jaundice,hearing damage of nuclear jaundice,tiny nuclear jaundice is the nerve dysfunction induced by bilirubin(bilirubin induced neurological dysfunction).3.Methods Using automatic biochemical analyzer to detected serum total bilirubin,conjugated bilirubin,serum albumin and B/A.Application of MRI screening equipment for Philips Ingénues 3.0T superconducting MR detector scanner.Children after discharge telephone follow-up ASQ-3.4.Follow-up During hospitalization and after discharge follow-up NBNA and ASQ.NBNA requirements: in quiet environment,half dark,warm indoor,nursing after 1 hour,10 minutes to complete.NBNA including six behavior ability:Eight active and passive muscle tension,the original reflection 3 items,three general condition.Each group has three score(0,1,2).Inspectors are all accepted the professional training of personnel.NBNA < 37 as the abnormal..ASQ-3: Parents and other major care completed the questionnaire.Five functional areas:Communication,Gross movements,Fine motor,Solving problems,Individual and society.The result : YES = 10,Sometimes = 5,NO = 0.Results 1.According to the presence of head MRI divided into abnormal group and normal group,Abnormal group of 13 cases(19.70%)and normal group and 53 cases(80.30%),According to the clinical symptoms and signs in BE group and not BE,not BE group of 57 cases(86.37%),A group of 9 cases(13.64%),compared between each group of gestational age,birth weight and hospital days of age,jaundice duration time and jaundice,compared with no statistical significance(P > 0.05),but each group between TSB and B/A was statistically significant(P < 0.05);2.Incidence of head MRI changes BE higher than no change group(x2=26.68 P<0.05),with head MRI changes as BE diagnostic criteria,sensitivity(88.8%),specific(91.2%).3.BE group ASQ-3 less than BE squared(x2 = 35.33,P < 0.05),BE NBNA below not BE group(t = 13.21,8.43,P <0.05),and have a statistics meaning.4.Head MRI abnormalities ASQ-3 is lower than normal group(x2 = 7.69,P < 0.05),in order to head MRI abnormalities as BE prognostic predictor,sensitivity(62.5%),specific(86.2%).5.Cranial MRI abnormalities NBNA is lower than normal group(t = 14.16,7.93,P< 0.05),with NBNA less than 37 points as abnormal standard,head MRI abnormalities NBNA incidence is higher than normal group,with head MRI as BE prognostic predictor,sensitivity64.7% and specialty 95.9%.6.ASQ joint NBNA as indicators of abnormal neurological development,prognosis of head MRI abnormalities in BE in sensitivity 83.2% and specific 86.7%.Conclusion 1.The blood bilirubin level and blood bilirubin/albumin ratio is to BE risk factors;2.High incidence of neurodevelopment abnormalities in BE or head MRI abnormalities in children's later development;3.MRI in the diagnosis of BE has good sensitivity and specific degrees;4.MRI in the prognosis of BE has good sensitivity and specific degrees;... |
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