| Objective:To analyze the etiology,clinical features and risk factors of severe hyperbiliru-binemia(serum total bilirubin ?427.5 umol/L)in full-term neonates and the complications of acute bilirubin encephalopathy(ABE),analyze the adverse reactions related to blood exchange in patients with blood exchange,It provides help for clinical prevention and early treatment of severe hyperbilirubinemia and neonatal bilirubin encephalopathy,and provides clinical evidence for the safety of blood exchange therapy?Methods:1.Retrospective collection of medical records of 413 full-term neonates diagnosed with severe hyperbilirubinemia who were hospitalized in the NICU of our hospital from January 2015 to December 2017;2.We analyzed all children with severe high blood bilirubin of etiology,clinical characteristics,and analyzed the general condition,etiology,cranial MRI,AABR and NBNA scores of the children with and without ABE,compared the differences between the two groups;3.The adverse reactions related to blood exchange were analyzed for patients undergoing synchronous blood exchange between peripheral arteries and veins.Results:1.413 cases of children with severe hyperbilirubinemia,including out neonatal ABO hemolytic disease 166 cases(40.19%),followed by 85 cases(20.58%)with unknown causes.There were 64 cases(15.50%)of infectious factors: 59 cases(14.29%)of Birth injury disease;2.There were statistically significant differences in TSB peak and jaundice age between ABO and RH incompatibility hemolytic diseases(P < 0.05);3.There were 126 cases with and 287 cases without ABE,multivariate Logistic regression analysis TSB(OR=1.012,95%ci 1.006-1.019),B/A(OR=1.053,95%ci1.012-1.096),postpartum weight loss(OR=1.055,95%ci 1.001-1.111),Rh incompa-tibility(OR=3.99,95%ci 1.242-12.937)and sepsis(OR=13.193,95% CI 2.998-58.057)were ABE risk factors;4.The area under the curve of TSB peak is 0.824,B/A is 0.811,TSB peak critical value is 529.4mol/L,B/A is 0.86,and the Youden index is the largest,which is 0.54(sensitivity 0.762,specificity 0.787)and 0.48(sensitivity 0.571,specificity0.913),respectively;5.The results of cranial MRI,AABR and NBNA score were compared between the ABE group and the non-ABE group were compared,and there was a statistical difference between the two groups(p < 0.05).The abnormal rate of cranial MRI and AABR in ABE group was significantly higher than that in non-ABE group,and the mean score of NBNA was also significantly lower than that in non-ABE group;6.Among the 257 patients who underwent blood exchange therapy,hyperglyce-mia(56.42%)was the most common,followed by thrombocytopenia(42.80%),metabolic acidosis(13.62%)and hypocalcemia(10.12%).There were 4 cases of severe adverse reactions,including 2 cases of apnea,1 case of NEC1 and 1 case of shock.ABE was present in 3 of the 4 patients with severe adverse reactions.Conclusions:1.ABO incompatibility is the main cause of severe hyperbilirubinemia in full-term neonates,followed by unknown etiology,infectious factors,birth injury diseases,and G6 PD deficiency;Rh incompatibility is rare,but jaundice is early and progresses quickly;2.TSB,weight loss after birth,Rh incompatibility and sepsis were ABE risk factors;Rh incompatibility and sepsis greatly increased the risk of bilirubin encephalopathy,requiring early recognition and active treatment;3.The peak value of TSB and B/A has certain clinical value in predicting ABE.When TSB is greater than 529.4mol/L and B/A is greater than 0.86,ABE should be guarded against;4.The most common adverse reaction of neonatal blood exchange therapy is the change of hematological index,which is mostly temporary and recoverable.The blood exchange therapy is relatively safe,but there are few serious adverse reactions. |
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