Clinical Characteristics And Prognosis Of Neonatal Hyperbilirubinemia Requiring Exchange Transfusion

Research backgroundNeonatal hyperbilirubinemia(NHB)is one of the common causes of hospitalization in the first week after birth,which can be occurred in 60% of full-term infants and 80% of premature infants.High levels of free bilirubin(Bf)will pass through the immature blood-brain barrier,leading to a series of nerve damage if not managed effectively.And acute bilirubin encephalopathy(ABE),kernicterus and even death will occur in some severe cases.The survivors may have neurologic sequelae such as athetoid cerebral palsy(CP),sensorineural deafness,gaze paralysis.Therefore,early identification and timely treatment are the key to preventing severe neurological complications such as kernicterus.Exchange transfusion in the treatment of neonatal severe hyperbilirubinemia was introduced in the early 1950s Exchange transfusion(ET)is the direct a nd effective measure to decrease serum bilirubin levels.The current main method is peripheral arteriovenous exchange transfusion.However,as an invasive procedure,exchange transfusion also has some risks.The short-term complication scaused by exchange transfusion,such as thrombocytopenia,hypocalcemia,an dmetabolic acidosis,are often asymptomatic and reversible.Severe complicatio ns such as necrotizing enterocolitis(NEC),disseminated intravascular coagulation(DIC)and pulmonary hemorrhage might occur,even causing life-threatening events.Therefore,we conducted research on infants with hyperbilirubinemia who underwent exchange transfusion analyzing the etiology,complications of exch ange transfusion,as well as risk factors of affecting the prognosis,so as to provide the evidence for clinical diagnosis and treatment.ObjectiveTo analyze the etiology,complications of exchange transfusion,as well as to identify the risk factors of affecting the prognosis in neonatal hyperbilirubinemia.MethodsFrom January 2015 to August 2019,a multicenter study was conducted in neonatal intensive care unit(NICU)of the Third Affiliated Hospital of Zhengzhou University,the First Affiliated Hospital of Zhengzhou University and Affiliated Children Hospital of Zhengzhou University.Infants of ≥ 35-week gestational age with hyperbilirubinemia who underwent ETs were recruited.The clinical data of infants was collected and followed up to 12 months.According to the follow-up results,infants were divided into normal outcome group and poor outcome group.The general characteristics,etiology,treatment and efficacy,complications of exchange transfusion of the two groups were analyzed.The risk factors of poor prognosis were identified by logistic regression analysis.Results1.A total of 494 newborns met the inclusion criteria,and 56 of them lost to follow-up.Among the 438 cases,374(85.4%)had normal prognosis,64(14.6%)had poor neurological prognosis,and 18(4.1%)died.2.Homologous immune hemolysis(64%)was the main cause of hyperbilirubinemia requiring exchange transfusion.3.The average decrease rate of serum bilirubin was(36.9 ± 13.3)% after ET.The main complications of exchange transfusion were thrombocytopenia(53.4%),hypocalcemia(25.8%),hypokalemia(25.3%).And severe complications were apnea(3%),convulsion(1.1%),respiratory failure(0.9%),death(0.9%),NEC(0.7%),heart failure(0.7%),DIC(0.5%).4.A total of 166 cases were diagnosed with ABE.3.3%(2/61)of BIND score 1-3(mild ABE)had poor prognosis,38.8%(26/67)of the score 4-6(moderate ABE)had poor prognosis,and 92.1%(35/38)of the score 7-9(severe ABE)had poor prognosis.There was significant difference in the incidence of poor prognosis among children with different BIND scores(χ~2 = 271.034,P<0.001).5.Logistic regression analysis showed that increased peak serum total bilirubin(TSB)(OR= 1.011,95% CI = 1.008-1.015,P < 0.001)and sepsis(OR = 4.539,95%CI = 2.093-9.843,P < 0.001)were risk factors for poor prognosis.Conclusions1.Homologous immune hemolysis was the main cause of hyperbilirubinemia requiring exchange transfusion.2.The complications of exchange trans fusion were mostly asymptomatic and reversible,but there were also serious complications,even endangering the lives of infants.3.BIND score had important value in evaluating the prognosis of neonatal hyperbilirubinemia requiring exchange transfusion.Elevated serum total bilirubin(TSB)and sepsis were risk factors for poor prognosis.