Clinical Analysis Of Severe Hyperbilirubinemia In326Neonates

Objective Investigating the reasons and predictors of poor outcome inneonates with severe hyperbilirubinemia to provide evidence for treatmentand better prognosis.Methods Data were collected for retrospective study on326neonateswith severe hyperbilirubinemia hospitalized between January1,2012andDecember31,2012.Results Infection(74.40%) and hemolytic disease(51.19%) were themain cause of severe hyperbilirubinemia.Threshold TSB is an independentrisk factor of poor outcome.55.60%of neonates had a TSB level measuredbefore admitted. The screening rate in the first24hours and72hours was4.91%,33.13%respectively. Group with hemolysis had a lower jaundice oradmission age and a shorter duration of jaundice but higher B/A ratio andincidence of exchange transfusion than the control group. The poor outcomewas usually not so serious and might be reversible in neonates with BINDscore of0-6, however, would usually be very severe when the score was7-9.Threshold TSB, USB and B/A ratio in group of poor outcome wassignificantly higher than the other group and the area under the ROC curve evaluating poor prognosis of these three indicators was0.682,0.671and0.698respectively. When TSB=474.5μmol/L, UCB=449.15μmol/L,B/A=0.923mg/g, Youden index is the largest. The incidence of a failedBAEP or NBNA test and hyperintense globus pallidus on T1W1was notsignificantly different in groups with or without poor outcome. Nosignificant difference was found in the result of auditory screening in groupswith or without neurologic performanceConclusions Strengthening the monitoring, follow-up and treatmentof neonatal jaundice to reduce the morbidity of severe hyperbilirubinemiaand kernicterus. Routine hearing screening should be practised on everyneonate jaundiced as the result is not consistent with neurologic performance.A pretreatment BIND score was a very good predictor of outcome. TSBthreshold, USB and B/A ratio are predictors of outcome. NBNA, hearingscreening and hyperintense globus pallidus on T1W1in the acute phase ofjaundice might not provide reliable information for neurologic prognosis.