Analysis Of Related Factors Of Hyperbilirubinemia In Late Preterm Infants

Purpose:Due to the immature bilirubin metabolism ability of late preterm infants,the etiology of hyperbilirubinemia is complex.If not treated in time,it will cause severe hyperbilirubinemia.In severe cases,it can lead to bilirubin encephalopathy,leaving neurological sequelae.By analyzing the clinical data of the late premature infants,the risk factors of hyperbilirubinemia and severe hyperbilirubinemia in the late premature infants were discussed in this study,so as to guide the early intervention of hyperbilirubinemia in the late premature infants,reduce the incidence of bilirubin encephalopathy in the late premature infants and improve the quality of life of the children.Methods:A total of 444 late preterm infants with gestational age of 34+0-36+6 weeks who were hospitalized in Changle people’s Hospital from January 2018 to December 2020were retrospectively analyzed,clinical routine close monitoring of bilirubin,Among them,198 children who met the diagnostic criteria of hyperbilirubinemia were set as the hyperbilirubin group;In the same period,246 children who did not meet the diagnostic criteria of hyperbilirubinemia were set as the control group.We investigated the basic and medical information about the two groups,including:(1)basic information of infants:sex,age,weight,gestational age;(2)characteristics of jaundice:the time of jaundice appearance,the peak time of jaundice,the time of jaundice regression;(3)Neonatal factors:history of asphyxia,delayed fecal excretion,maternal and infant blood group incompatibility,infection,feeding intolerance,hypoproteinemia,polycythemia,temporary hypothyroidism,cranial hematoma,intrauterine distress;(4)maternal factors:delivery mode(cesarean section/vaginal delivery),parity(primipara/multipara),maternal age(<35 years old),mode of pregnancy(natural pregnancy/assisted reproduction),multiple pregnancy,gestational diabetes,gestational hypertension,thyroid disease during pegancy,heart disease,kidney disease,anemia,premature rupture of membrances,placental abruption,history of oxytocin use,history of glucocorticoid use,residence(urban/rural);(5)The degree and outcome of jaundice.SPSS22.0 was used for statistical analysis.The above factors of the two groups were compared and analyzed,and the significant factors of single factor analysis were included in the multi factor Logistic analysis.Results:(1)The incidence of hyperbilirubinemia in late preterm infants was 44.59%.There was no significant difference in gender,body weight and gestational age between the case group and the control group(P>0.05).(2)Univariate analysis showed that:(1)Neonatal factors:Compared with the control group,the infants with hyperbilirubinemia had a higher frequency of history of asphyxia(χ~2=16.45,P<0.05),delayed fecal defecation(χ~2=18.68,P<0.05),maternal and infant blood group incompatibility(χ~2=86.43,P<0.05),infection(χ~2=10.61,P=0.02),feeding intolerance(χ~2=34.49,P<0.05),hypoproteinemia(χ~2=10.63,P=0.02),polycythemia(χ~2=12.90,P=0.01),temporary hypothyroidism(χ~2=10.63,P=0.02),cranial hematoma(χ~2=9.33,P=0.03),intrauterine distress(χ~2=18.47,P<0.05),the difference was statistically significant(P<0.05).(2)Maternal factors:the mothers of the infants with hyperbilirubinemia had higher frequency of advanced maternal age(≥35y)(χ~2=12.50,P<0.05),gestational diabetes mellitus(χ~2=30.19,P<0.05),hypertension during pregnancy(χ~2=18.97,P<0.05),thyroid disease during pregnancy(χ~2=15.41,P<0.05),premature rupture of membranes(χ~2=25.63,P<0.05),the difference was statistically significant(P<0.05);however,the frequency of vaginal delivery,transparturient women,assisted production,twins,heart disease,renal disease,anemia,placental abruption,history of oxytocin use,history of glucocorticoids,residence in rural areas had no significant different between two groups(P>0.05).(3)Factors which had significant difference between two groups in the univariate analysis were included in the multivariate Logisitc analysis,the independent risk factors for hyperbilirubinemia were:feeding intolerance(OR=4.45),cephalic hematoma(OR=3.06),hyperhememia during pregnancy(OR=2.48),infection(OR=1.87),maternal infant blood group incompatibility hemolysis(OR=1.84),intrauterine distress(OR=1.77),premature rupture of membranes(OR=1.66),and asphyxia(OR=1.64)and polycythemia(OR=1.05).(4)The characteristics of jaundice in the case group and the control group:jaundice appeared earlier in the case group than the control group(t=4.73,P<0.05),the peak hour was earlier(t=3.06,P<0.05),jaundice subsided late(t=6.39,P<0.05).(5)There were 78 cases of moderate to severe hyperbilirubinemia and 128 cases of mild to moderate hyperbilirubinemia,univariate analysis showed that:compared with mild to moderate hyperbilirubinemia group,maternal and infant blood group incompatibility(χ~2=21.71,P<0.05),infection(χ~2=4.51,P=0.03),feeding intolerance(χ~2=6.74,P<0.05),hypertension during pregnancy(χ~2=7.73,P<0.05)and premature rupture of membranes(χ~2=7.08,P<0.05),the difference was statistically significant(P<0.05);The results showed that feeding intolerance(OR=5.27),maternal infant blood group incompatibility hemolysis(OR=4.93)and gestational hypertension(OR=4.31)were independent risk factors for severe hyperbilirubinemia in late preterm infants.Conclusion:1.Feeding intolerance,infection,maternal infant blood group incompatibility hemolysis,hematoma,intrauterine distress,history of neonatal asphyxia,gestational hypertension and premature rupture of membranes were independent risk factors of hyperbilirubinemia in late preterm infants.2.Feeding intolerance,maternal infant blood group incompatibility hemolysis and gestational hypertension are independent risk factors for severe hyperbilirubinemia in late preterm infants.