| Objective:The purpose of this article was to study the etiology and risk factors of bilirubin encephalopathy;to analyze the sensitivity and specificity of serum bilirubin concentration and B/A ratio in the diagnosis of bilirubin encephalopathy;to explore the changes in MRI signal of brain and brainstem auditory evoked potential and the relationship between neurobehavioral measurement and bilirubin encephalopathy.Methods:1.A retrospective analysis method was used to collect a total of 197 children with severe hyperbilirubinemia admitted to the Department of Neonatal Medicine,the First Affiliated Hospital of Kunming Medical University from January 2017 to October 2019.They were set as the study group of 81 children with acute bilirubin encephalopathy hospitalization 116 children with severe hyperbilirubinemia,but no bilirubin encephalopathy were diagnosed as the contral group.The clinical data of the children were analyzed,including the basic conditions,test results,and imaging examinations of the children.Statistical analysis of the data was carried out to explore the occurrence of neonatal gallbladder.The risk factors of neonatal bilirubin encephalopathy were analyzed.2.Venous blood was collected to check liver function after admission of the two groups of children,and tolal serum bilirubin value was calculated.B/A ratio was calculated,and ROC curve was drawn.The d sensitivity and specificity of serum bilirubin concentration and B/A ratio in the diagnosis of bilirubin encephalopathy in two groups of children were analyzed.3.The changes of skull MRI and BAEP in children with bilirubin encephalopathy were recorded.Results:1.This study included 81 cases of bilirubin encephalopathy in the study group,50 males(61.73%),31 females(38.27%),116 non-bilirubin encephalopathy and 70 males(60.34%),46 females(39.66%).There was no statistically significant difference of sex ratios between the two groups.The daily age of peak bilirubin,gestational age,birth weight,hospital weight,weight loss ratio of children in the study group were 6.69 ± 3.38 days,38.83 ± 1.28 weeks,3213.09 ± 427.42g,-3.63±5.83%.The daily age of peak bilirubin,gestational age,birth weight,hospital weight,weight loss ratio of children in the control group were 7.20±3.46days,38.93±1.08weeks,3184.62±421.58g,-2.96±4.69%.P>0.05,which were no statistical significance;mothers with gestational diabetes mellitus in 11cases(13.6%),mothers with pregnancy-induced hypertension in 2cases(2.5%),there were 24 cases(29.6%)of children with infectious diseases and 2 cases(2.5%)of asphyxia at birth in the study group.There was no significant difference between the study group and control group.2.Children in the bilirubin encephalopathy group and the non-bilirubin encephalopathy group were exclusively breastfed,had jaundice at 24 hours,time of admission,bilirubin concentration,B/A ratio,combined bleeding disorders,NBNA score,BIND score,BAEP,the abnormal signal of cranial MRI were statistically significant(P<0.05).Through multivariate logistic regression analysis of the risk factors of the two groups of children,the results showed that TSB,Bind score and BAEP detection were high-risk factors for bilirubin encephalopathy(P<0.05),and the corresponding OR values were 1.014,19.784,143.1194.3.By plotting the area under the ROC curve>0.5,it was concluded that the total bilirubin peak value of 391.55umol/L and B/A ratio 6.835 were highest in sensitivity and specificity for the diagnosis of bilirubin encephalopathy,respectively(0.444 And 0.759,0.235 and 0.9222).4.In the bilirubin encephalopathy group,the proportion of children with BAEP abnormalities(including single ear abnormalities and binaural abnormalities)was 69(85.2%),and the detection rate was high;Cranial MRI showed 81 cases(100%)of abnormal symmetry signals of bilateral globus pallidus and basal ganglia T1WI.The difference between the two groups of children in BAEP and cranial MRI examination was statistically significant(t=119.5495,23.7455,P<0.05).Conclusion:1.The occurrence of acute neonatal bilirubin encephalopathy might be related to the earlier occurrence of jaundice,higher peak bilirubin concentration,large bigger B/A ratio,exclusive breastfeeding,and birth canal injury disease.The bilirubin concentration and B/A ratio had higher sensitivity and specificity in the diagnosis of acute neonatal encephalopathy.2.The concentration of bilirubin and B/A ratio were positively correlated with the occurrence of bilirubin encephalopathy.When the total bilirubin peak value of the children was greater than 391.55umol/L and the B/A ratio was greater than 6.835,A high degree of highly vigilance was showed for the risk of bilirubin encephalopathy.3.BAEP and head MRI may have a great predictive value in the early diagnosis of bilirubin encephalopathy. |
PDF Full Text Request