| Objective:The clinical data of the newborn with neonatal hyperbilirubinemia was retrospectively analyzed to investigate the risk factors for neonatal acute bilirubin encephalopathy.Methods:The medical records of the newborn with severe hyperbilirubinemia(mainly indirect bilirubin increased)or whose bilirubin level up to the standard for blood exchange and gestational age of 35 weeks or above were collected in a Grade III A Children’s Hospital in Hunan province from January 1,2010 to December 31,2019.Data on the total number of neonatal hospitalizations and neonatal hyperbilirubinemia during the same period were obtained as baseline.The proportion of neonatal hyperbilirubinemia,the incidence of moderate to severe hyperbilirubinemia and the incidence and changes of neonatal acute bilirubin encephalopathy were retrospectively analyzed.All patients were divided into acute neonatal bilirubin encephalopathy group(ABE group)and not neonatal acute bilirubin encephalopathy group(NABE group),The single factor analysis of meaningful variables,the inclusion standard is P<0.2,and the binary logistic regression analysis is performed.Screen the risk factors of neonatal acute bilirubin encephalopathy in children with severe hyperbilirubinemia.Outcomes:(1)Epidemiological data: the overall incidence of acute neonatal bilirubin encephalopathy in this hospital has been decreasing since 2010 to 2019,but there was no statistical significance in the incidence of the two adjacent years(P>0.05).According to the chi-square segmentation test principle,the retest of the adjacent two years with no statistically significant difference indicated that the differences between 2010～2011and 2012 ～ 2017 and 2012 ～ 2017 and 2018 ～ 2019 were statistically significant(P < 0.01),and showed a downward trend.(2)A total of 23,663(23,663/60487,39.12%)patients were diagnosed with hyperbilirubinemia in the neonatal department of our hospital from2010 to 2019.There were 8073(8073/23663,34.12%)children with severe hyperbilirubinemia,and 669(669/8073,8.28%)patients with neonatal acute bilirubin encephalopathy.(3)There were 699 cases of neonatal acute bilirubin encephalopathy,including 180(26.92%)cases of acidosis,56(8.37%)cases of neonatal ABO hemolysis,32(4.78%)cases of neonatal RH hemolysis,127(18.98%)cases of internal hemorrhage,222(33.18%)cases of G6 PD deficiency.(4)Univariate analysis results showed that proportions of the newborn with internal hemorrhage,G6 PD deficiency,sepsis,other infections,intestinal diseases,RH hemolysis,ABO hemolysis,acidosis,premature rupture of membranes,cesarean delivery,whose mother had at least twice pregnancies and gave birth twice or more times,those born below the county level in ABE group were significantly higher than that in the NABE group(P<0.05).Compared with the NABE group,the ABE group witnessed younger day age and peak day age(P < 0.001),lower birth weight and admission weight(P<0.005).The ABE group also showed lower hemoglobin and albumin levels(P<0.001),higher value of B/A ratio and peak value of TSB(P<0.001).(5)Multivariate Logistic regression analysis showed that G6 PD deficiency(OR:1.743,P < 0.002),living in urban and rural areas(OR:1.516,P < 0.020),the peak value of TSB(OR:1.032,P <0.001),hemoglobin level(OR:0.99,P<0.001),day age at hospitalization(OR:0.928,P<0.020),weight at birth(OR:0.999,P<0.034)were independent risk factor for acute bilirubin encephalopathy.Among the 6variables,the descending order is G6 PD deficiency,residence in rural areas,peak value of TSB,high birth weight,low hemoglobin,young day age at hospitalization.Conclusion:1.The number of cases and incidence of neonatal acute bilirubin encephalopathy showed a decreasing trend during 2010～2019.2.The risk factors for neonatal acute bilirubin encephalopathy were G6 PD deficiency,the residence was in rural areas,the peak value of TSB,low birth weight,low hemoglobin,and young birth-day age. |
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