Clinical And Prognostic Analysis Of Neonatal Acute Bilirubin Encephalopathy

Objective: To investigate the risk factors of neonatal acute bilirubinencephalopathy and the prognosis.Methods:1.We choose neonates diagnosed with acute bilirubin encephalopathy(warning or spasm period) in Children’s Hospital of Chongqing MedicalUniversity during January1,2009to December26,2013as the observationgroup; the ones without any sings or symptoms of warning and spasmperiod and cranial MRI showed no changes of kernicterus withhyperbilirubinemia as a control group.（all the TSB is at a level at whichexchange transfusion is recommended according to the APPguidelines）.Compare the TSB peak levels,B/A value,gestational age,age inoccur days, the rate of Rh hemolysis,ABO hemolysis,G6PDdeficiency,acidosis,sepsis, hyperglycemia,BAEP,oto acoustic emissionshearing screening et al.2.We also divide the patients into two groups according to the goodprognosis and bad ones (including CP,atypical kernicterus,death),andanalyse the differences between them in TSB peak levels,B/Avalue,gestational age,age in days,occur days, the rate of Rh hemolysis、ABO hemolysis,G6PD deficiency,acidosis,sepsis, hyperglycemia,BAEP,otoacoustic emissions hearing screening et al. Results:1.There are42cases of bilirubin encephalopathy in the Observation group，of which30are males and12are females. there are four pretermcases,theminimum gestational age is30weeks, and the maximum one is41.29weeks.6cases suffered asphyxia,19cases had ABO hemolytic disease,9cases had Rh hemolytic disease, one case had ABO hemolytic diseasecombined with Rh hemolytic disease, there are7cases with G6PDdeficienc. one case had cranial hematoma,six cases had intracranialhemorrhage.there are19cases suffered acidosis and9cases with sepsis.There are three cases whose brain MRI with typical manifestations of acutebilirubin encephalopathy. Telephone follow-up: five cases developedcerebral palsy, three cases have atypical abnormalities, nine cases died afterdischarge,2patients died during hospitalization,7cases have no obviousabnormalities,16cases lost telephone follow-up.2.The case group has higher average TSB level、B/A value.The neonatesfrom the control group had a longer average hospitalization duration. Thecase group also had higher proportion of sepsis， acidosis， BAEPabnormalities comparing with the control group.More neonates directlycame from rural home in the case group.All the differences above arestatistically significant.3.The area under the ROC curve of B/A is0.855, P value is0.000,0.63isthe best cut, when the sensitivity is0.86and specificity is0.67.4.There is one case whose TSB level did not meet the blood exchangetransfusion criteria and also did not get blood exchange transfusiontreatment but later developed into CP,laboratory findings proved this casesuffered from G6PD deficiency.Otherwise there are three cases whoseTSB levels meet the blood transfusion criteria but due to their parents’srejection they did not get blood transfusion therapy, but all of them are normal when follow-up.5.There were3cases,whose MRI brain revealed typical manifestations ofABE(high signal intensity in the globus pallidus bilaterally on T2weightedimages),suffering from cerebral palsy.6. Abnormality rate of Cranial MRI in the poor prognosis group is higherthan the good prognosis group, which difference was statisticallysignificant, all the cases with normal brain MRI were normalwhenfollow-up.The rate of BAEP abnormalities is higher in the proportion ofpoor prognosis group compared with good prognosis group (P value:0.036).Conclusion:1.The high level of peak TSB is still an important risk factor for bilirubinencephalopathy, in addition, higher B/A ratio， acidosis， sepsis,hyperglycemia，Rh hemolytic disease，shorter hospital duration，comingfrom rural home are the other important risk factors for bilirubinencephalopathy.2.Takeing0.63as a cut point of B/A value (mg/g) is optimal At thispoint，this value corresponds to a sensitivity of0.86and a specificity of0.67..3.It is not reliable to predict the prognosis just based on the clinicalstages,because the neonates who were in spastic period can recover whilethe ones who had the clinical manifestation of warning period could dieduring hospitalization or after their discharge from hospital.4. Running BAEP check is more significant than OAE hearing screeningwhile suspecting the diagnosis of acute bilirubin encephalopathy,because itis the auditory nerve nucleus in the the brain stem that bilirubin tend todamage. 5.The pathogenesis of bilirubin encephalopathy is not fully understood bynow. There is no reports about prognostic factors of bilirubinencephalopathy currently, according to the results of this case analysis,Running cranial MRI and BAEP examination is necessary to predict theprognosis of bilirubin encephalopathy.