| Objective To investigate the clinical significance of IGF-1 on predication and therapeutical evaluation in the hyperbilirubinemia of premature neonates.Method Admitted premature neonates in the NICU of gestational age from 28 weeks to 37 weeks before were enrolled in the Second Affiliated Hospital of Anhui Medical University from November 2014 to November 2015. The premature neonates with congenital hepatobiliary malformations, neonatal hemolytic disease, genetic metabolic diseases, choking, sepsis and trauma were excluded. Serum IGF-1 level was tested and the body weight was recorded at the first day after birth. The peak values of TSB and the duration of phototherapy were recorded. Based on gestational age, the premature neonates included were divided into the three groups, which were early premature neonates group(28 weeks ≤ gestational age < 32 weeks), moderate premature neonates group(32 weeks ≤ gestational age < 35 weeks) and late premature neonates group(35 weeks ≤ fetal age < 37 weeks). The levels of IGF-1 were compared in the three different groups. Depending on the response to the initial phototherapy, the premature neonates were divided into the sensitive group and the non-sensitive group, IGF-1 levels were compared between the two groups; Based on the results of MRI, premature neonates were divided into the group with abnormal sign and the group with normal sign in globus pallidus, the difference of the IGF-1 levels between the two groups was analyzed.Results 36 cases were included in the study, all were diagnosed as hyperbilirubinemia. 12 cases were enrolled respectively in the early premature neonates group, the moderate premature neonates group and the late premature neonates group. Each group had six male and six female. Serum IGF-1 level was 12.8 ± 2.0 ng/ml in the early premature neonates group,28.1 ± 17.2 ng/ml in the moderate premature neonates group and 42.5 ± 12.8 ng/ml in the late premature neonates group. The body weight was 1571.7 ± 260.4 g in the early premature neonates group, 2225.8±376.0 g in the moderate premature neonates group and 2526.7 ± 181.2 g in the late premature neonates group. The peak value of TSB was 212.3 ± 36.0 umol/l in the early premature neonates group, 196.6 ± 42.9 umol/l in the moderate premature neonates group and 192.8 ± 32.1 umol/l in the late premature neonates group. Significant differences of serum IGF-1 and the body weight were found(p<0.05) in the three groups, however no Significant differences of the peak values of TSB were found(p> 0.05). Serum IGF-1 levels were correlated closely with the body weights(r = 0.73, p <0.05). No significant correlation between the IGF-1 levels and the peak values of TSB was found(p> 0.05). All premature neonates received phototherapy. The sensitive response to the phototherapy was observed in 13 cases. Serum IGF-1 levels in the sensitive group of phototherapy were 39.6 ±17.7 ng/ml which was significantly more than the insensitive group 21.1 ± 13.2 ng/ml(p <0.05); The Serum IGF-1 levels were negatively correlated with the duration of phototherapy(r=-0.70, p <0.05). Abnormal T1W1 sign in the globus pallidus was showed in 3 cases. Serum IGF-1 levels in the group with abnormal sign in the globus pallidus were 10.8 ± 0.4 ng/ml, which was significantly lower than the group with normal sign 13.4 ± 2.2 ng/ml(p <0.05). However the peak values of TSB were 223.9±21.2umol / l in the group with abnormal sign in globus pallidus, which had no significant difference with the normal sign group 205.1 ± 38.8umol / l(p> 0.05).Conclusions 1. Serum levels of IGF-1 might be an indicator which reflected fetal growth and maturity. 2. IGF-1 did not predict the serum peak value of the TSB in premature neonates. 3. IGF-1 reflected the recuperative ability of the body to process bilirubin. 4. Low serum IGF-1 levels were more prone to appear abnormal sign in globus pallidus even though the same peak values of TSB existed in premature neonates.Serum IGF-1 levels reflected the tolerance of the body to hyperbilirubinemia in premature neonates. |
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