Retrospective Clinical Analysis Of 295 Cases Of Neonatal Hyperbilirubinemia And Risk Factors Of Bilirubin Encephalopathy

Objective The clinical data of 295 cases of neonatal hyperbilirubinemia were retrospectively analyzed to explore the clinical characteristics and prognosis of neonatal hyperbilirubinemia,so as to provide reference for early diagnosis,timely intervention and effective prevention of neonatal hyperbilirubinemia.By analyzing the risk factors of bilirubin encephalopathy,we can provide clinical basis for children with bilirubin encephalopathy to identify these risk factors early and take urgent and effective treatment measures to reduce the mortality of bilirubin encephalopathy in children with bilirubin encephalopathy.Methods The clinical data of 295 newborns with hyperbilirubinemia hospitalized in the department of neonatology in a grade a hospital in hubei province on January 1,2016 solstice and February 28,2019 were retrospectively analyzed.The subjects can be divided into hemolytic jaundice of newborns and non-hemolytic jaundice of newborns according to the etiology,compared two groups of children with clinical data,including children generally(gender,gestational age,birth weight and maternal age),laboratory biochemical indicators(total bilirubin peak in low,low hemoglobin,red blood cell count,reticulocyte counting red peak,myocardial enzymes),ending index(total hospital days of age,hospitalization days,phototherapy time,change rate,blood transfusion rate,bilirubin encephalopathy incidence and case fatality rate)for clinical analysis,to understand the clinical characteristics of high neonatal bilirubin levels,different etiologies.According to the complications(typical neurological manifestations of bilirubin encephalopathy + skull mri results report abnormalities),the children were divided into the bilirubin encephalopathy group and the non-bilirubin encephalopathy group.The clinical data of the two groups were compared to analyze the risk factors related to bilirubin encephalopathy.The database was established,and the data were double-checked by Excel,and statistical analysis was conducted by SPSS22.0 software,P < 0.05 was considered as statistically significant difference.Non-conditional Logistic regression was used to analyze risk factors,and the results were expressed by likelihood ratio(OR)and 95% confidence interval,P < 0.05 indicated statistically significant differences.Results(1)295 cases of neonatal hyperbilirubinemia were observed,including 164 cases of male(55.6%)and 131 cases of female(44.4%).According to the different causes of jaundice,202 cases(68.5%)were divided into non-incompatible hemolytic jaundice.There were 93 cases(31.5%)of hemolytic jaundice due to blood group incompatibilities.There was no significant difference in general conditions(gender,gestational age,birth weight,and maternal age)between the two groups(p > 0.05).(2)The results of the case-control study showed that there were statistically significant differences between the hemolytic group and the non-hemolytic group in the length of admission,total phototherapy time,length of stay,peak value of total bilirubin,low value of hemoglobin,low value of red blood cell count,peak value of reticulover-count,transfusion rate and prevalence of bilirubin brain(P < 0.05).There were no significant differences in myocardial enzyme,exchange rate and mortality between the hemolytic group and the non-hemolytic group(P > 0.05).(3)A total of 295 cases of neonatal hyperbilirubinemia in the department of neonatology of a third-grade grade a hospital in hubei province were collected.On two groups of children with single factor analysis results show that the peak value of total bilirubin,neonatal hemolysis,infection,jaundice in time(1 day or less,1-3 days,3 days or higher),metabolic acidosis,bilirubin/albumin(B/A)ratio and jaundice intervention time have an effect on the occurrence of bilirubin encephalopathy,the difference was statistically significant(P < 0.05);Delivery mode,birth weight,history of asphyxia and hypoxia,hypoalbuminemia and breastfeeding had no effect on the occurrence of bilirubin encephalopathy,and the difference was not statistically significant(P > 0.05).(4)Unconditioned Logistic regression analysis showed that jaundice onset time,neonatal hemolysis,TSB peak,infection,B/A and metabolic acidosis were independent risk factors of bilirubin encephalopathy(OR > 1).Conclusion(1)Neonatal jaundice appears depends on the degree of jaundice time,red blood cell damage and liver metabolism of bilirubin,jaundice appears earlier,the more red blood cell damage,the faster the progress,the illness is heavier,the newborn hemolytic jaundice is non hemolytic jaundice,jaundice appear earlier,hospital early day age,total bilirubin high peak,total phototherapy time extended,increased hospitalization days,bilirubin encephalopathy incidence increased,at the same time,hemoglobin and red blood cell count is lower than the hemolysis,reticulocyte red count is higher than the hemolysis,blood transfusion rate increase;(2)Jaundice onset,neonatal hemolysis,peak total bilirubin,infection,B/A and metabolic acidosis are independent risk factors for bilirubin encephalopathy.Early identification of these risk factors and urgent and effective treatment can help reduce the morbidity and mortality.