The Study Of Correlation Between Bilirubin:albumin Ratio And Neuroelectrophysiology In Children With Hyperbilirubinemia

Objective To investigate the association between bilirubin-albumin ratio and a EEG,MRI,brainstem evoked potential by monitoring the bilirubin-albumin ratio in children with hyperbilirubinemia.To explore sensitive indicators of brain damage in children with hyperbilirubinemia.Study design From January 2016 to June 2018,163 neonates with full-term normal birth weight,who were diagnosed as neonatal hyperbilirubinemia,were enrolled in the neonatology department,including 80 males and 83 females.The children were divided into bilirubin encephalopathy group(group EPA)and non-bilirubin encephalopathy group(group EPN).According to typical head MRI findings,the children were divided into abnormal group(group MRA)and normal group(group MRN).According to the results of auditory brainstem evoked potential,the children were divided into positive abnormal group(group EEGA)and normal group(group EEGN);according to the amplitude integrated EEG results,the children were divided into abnormal group(group ABA)and Normal group(group ABN).1.All patients were enrolled in the hospital for 24 hours to complete the amplitude integrated EEG.On the second day,the blood total bilirubin and serum albumin were monitored.After3 days,the MRI was performed.After 1 week,the auditory brainstem response was improved.Differences between total bilirubin and B/A,and the relationship between total bilirubin and B/A ratios with head MRI,auditory brainstem evoked potentials,and amplitude integrated EEG,were all analyzed.(1)All children accepted EEG amplitude,MRI examination of the head,and auditory brainstem response;(2)Analysis the data of age,sex,gestational age,age,and birth weight of each group;(3)Monitoring Total bilirubin and serum albumin,comparing the difference between total bilirubin and B / A in each group;(4)doing ROC curve,comparing serum total bilirubin and B / A ratio,The diagnostic value of EEG combine with B / A ratio;(5)Analysis of the relationship between total bilirubin and B / A ratio and head MRI,auditory brainstem evoked potential and amplitude integrated EEG.Result 1.A total of 163 children with neonatal hyperbilirubinemia were enrolled,including 80 males and 83 females.22 infants were with encephalopathy,141 were with non-encephalopathy.Group MRA had 19 infants and Group MRA had 144 infants.Group EEGA had 11 infants and EEGN had 152 infants.Group ABA had 35 infants and ABN had 128 infants.There were no significant differences in age,gender,gestational age,age,birth weight,and hospital weight between the control groups.The etiology of the encephalopathy group and the non-encephalopathy group were Statistical differences.2.Comparison of total bilirubin and B/A values ? ? between groups: There was a statistically significant difference in total bilirubin and B/A between EPA group and EPN group,MRA group and MRN group(P<0.05).EEGA group There was no significant difference in serum total bilirubin between the EEGN group,the ABA group and the ABN group(P>0.05),but there was a statistically significant difference in the B/A ratio(P<0.05).The ABA group and the ABN group were bilirubin.There was a statistically significant difference in the incidence of encephalopathy(P < 0.05).3.Serum total bilirubin and B/A ratio predict bilirubin encephalopathy value comparison: the area under the ROC curve of serum total bilirubin and B/A ratio is0.824,0.873,respectively,and the area under the amplitude-integrated EEG severe abnormal ROC curve was 0.804,the area under the ROC curve of the amplitude integrated EEG severe abnormality + B/A ratio > 5.7 combined predicted of bilirubin encephalopathy was 0.954,the prediction sensitivity was 0.883,and the specificity was 0.916.4.The r values ? ? of serum total bilirubin,B/A ratio and head MRI results were0.552 and 0.629,respectively.The r values ? ? of serum total bilirubin,B/A ratio and auditory brainstem evoked potential were 0.157 and 0.325,respectively.The r values ? ? of serum total bilirubin,B/A ratio and amplitude integrated EEG were0.479 and 0.652,respectively.Conclusion 1.The ratio of B/A is a sensitive indicator for predicting hypertoxicity of hyperbilirubinemia,and the predicted value is superior to serum total bilirubin;2.The correlation between B/A ratio and head MRI,auditory Auditory brainstem response and amplitude integrated EEG is better than serum total bilirubin;3.Amplitude integration EEG is a good indicator to evaluate the neurotoxicity of bilirubin,which can early respond to brain damage caused by hyperbilirubinemia and guide clinical intervention and treatment as soon as possible.4.The bilirubin-albumin ratio combined with amplitude EEG monitoring has important value in early prediction of neonatal bilirubin encephalopathy.