| Objective: To analyze the clinical features and prognosis of preterm infants who have reached the standard of exchange transfusion of biliubin,and to compare the short-term prognosis and neurodevelopmental outcomes between exchange transfusion therapy and non-exchange transfusion therapy,and provide clinical evidence for the prevention and treatment of severe hyperbilirubinemia in preterm infants.Methods: A prospective case-control study was conducted.160 preterm infants with serum transreported serum bilirubin from year 2014 to 2016 were included in the study and divided into exchange transfusion group and non-exchange transfusion group.Clinical data were collected,Follow-up was performed at the correct age of 6 months.Infant and child intellectual development scales were used to assess the development of the nervous system and the differences in neurodevelopmental outcomes between the transfusion group and the non-exchange group were compared.According to the presence or absence of neurodevelopmental injury,they were divided into normal neurodevelopment group and neurodevelopmental injury group.The clinical data were compared between the two groups and the risk factors affecting neurodevelopment were analyzed.Results:1.From year 2014 to 2016,Hunan Provincial Children’s Hospital received 4748 preterm infants,and 160 premature infants with bilirubin reached the standard of blood transfusion,accounting for 3.4%,including82 transfusions,accounting for 1.7%,and 78 non-exchange transfusions,accounting for 1.7%.2.A total of 160 preterm infants with bilirubin exchange transfusion criteria were included in this study,of whom 15.0%(24/160)were hospitalized at or less than 72 hours of age,and 37.5%(60/160)were included at 72 hours to 7 days,47.5%(76/160)were more than 7days.gestational age≤32 weeks accounted for 6.9%(11/160),32w~34w accounted for 10.0(16/160)%;≥ 34 weeks accounted for 83.1%(133/160).1.90%(3/160)of patients weighing less than 1500 g,37.5%(60/160)accounted for 1500 ~ 2500 g,60.6%(97/160)of >2500g,The peak value of TSB was(433.2±100.6)μmol/L.3.Among the 160 preterm infants whose bilirubin reached the transfusion standard,119 were cured(74.4%),33 were improved(20.6%),and 8 patients(5.0%)died after giving up treatment.Of the 152 patients,follow-up to correct age at 6 months survived and the data were complete in 137 cases(90.1%).During follow-up of children until the age of 6 months,the abnormal ratio of BAEP in the peak TSB ≥428 μmol/L group,the proportion of globus pallidus T2 WI,the proportion of MDI<70,the proportion of PDI <70,and the proportion of MDI and PDI <70were higher than the peak TSB was <428μmol/L(c2=14.851,p<0.001;c2=6.820,p=0.033;c2=13.263,p<0.001;c2=13.082,p<0.001;c2=13.263,p<0.001).4.Among the 137 cases,31 cases(22.6%)suffered from neurodevelopmental impairment.In the neurodevelopmental injury group,the birth weight of the injury group was lower than that of the normal group(t=2.180,p=0.031),and the TSB peak value and B/A value were higher than the normal group(t=5.033,p=0.001;t = 5.067,p = 0.001);the proportion of children with gestational age <32 weeks in the injured group was higher than that in the normal group(c2 = 4.616,p = 0.032;c2= 7.524,p = 0.006),and the difference was statistically significant.Logistic regression analysis revealed that gestational age <32 weeks was a risk factor for neurodevelopmental impairment in preterm infants with bilirubin transfusion criteria(OR=2.409,p=0.031).5.There were 70 cases with TSB peak at 342~428μmol/L.General information,including sex,gestational age,admission age,delivery style,birth weight,bilirubin peak value,and B/A value were not significantly different between the two groups(p>0.05),the two sets of data are comparable.The blood transfusion therapy group compared with the non-transfusion group,the hospitalization cost was higher than the non-exchange group,and the hospital stay was longer than the non-exchange group(z=3.382,p=0.001;z=5.202,p=0.001).The difference was statistically significant.6.The peak of TSB was 342~428μmol/L in 70 cases,47 cases were cured(67.1%),21 cases(35.0%)were improved,and 2 cases(2.9%)died after discharge.Sixty-one patients completed follow-up at the correct age of 6 months and 9 patients were lost to follow-up.In follow-up cases,the proportions of MDI <70 points,PDI <70 points,MDI and PDI <70 points were not significantly different between the two groups.(p=0.245;p=0.982;p=0.245;p=0.361).Conclusions:1.The gestational age <32 weeks is a risk factor for the recent neurodevelopmental damage in preterm infants who have achieved bilirubin exchange transfusion standard.2.The serum total bilirubin peak value was 342~428μmol/L.There was no difference in the recent neurodevelopmental outcomes between exchange transfusion therapy and non-exchange transfusion therapy,but the transfusion group had higher hospitalization costs and longer hospital stay. |
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