The Effect Of Bilirubin And Its Changes On Neonatal Hyperbilirubinemia With Necrotizing Enterocolitis

Objective: To explore the role of bilirubin and its changes in concurrent necrotizing enterocolitis with hyperbilirubinemia of the newborn,so as to provide new ideas for prevention and treatment of NEC.Methods: Patients with hyperbilirubinemia who were admitted to the neonatal center of Children's Hospital of Chongqing Medical University from January 2015 to September 2018,and who developed NEC and modified Bell stage II or above during their hospitalization were selected as the NEC group,which was divided into two groups according to gestational age: the premature infant group(gestational age greater than or equal to 35 weeks and less than 37 weeks),and the term infant group(gestational age less than 37 weeks).According to the gestational age and birth weight,the patients who were hospitalized with neonatal hyperbilirubinemia at the same period and did not develop NEC during hospitalization were randomly selected as the non-NEC group at the ratio of 1:4.Clinical data of the two groups were retrospectively analyzed,including the peak bilirubin,baseline TSB,baseline UCB,TcB on the firstday,TcB on the second day,TcB on the third day,and some pregnancy and prenatal factors.SPSS 23.0 statistical software was used to analyze the data to investigate the possible effect of bilirubin and its changes on concurrent necrotizing enterocolitis with hyperbilirubinemia of the newborn.Results: A total of 39 cases of NEC group and 156 cases of non-NEC group were included in this study.There was no significant difference in gender,gestational age and birth weight between the NEC group and the non-NEC group(P>0.05).There was no significant difference in the peak bilirubin,baseline TSB,baseline UCB,and bilirubin changes within 3 days of admission in the premature infant group(P>0.05).In the term infant group,the baseline bilirubin was lower in patients with NEC than in patients without NEC(P<0.05).The change of bilirubin was mainly due to the difference on the first day of admission.After effective treatment,the bilirubin could be reduced to the ideal level.In addition,the ratio of cesarean section and IVIG application in the NEC group was higher than that in the non-NEC group(P<0.05).Conclusion: Bilirubin may have a protective effect on the intestinal tract of newborn,and bilirubin level has potential value in evaluating the risk of NEC.The effect of bilirubin on the pathogenesis of NEC needs to be further confirmed.Intravenous immunogloblin in the treatment of neonatal hemolytic disease may increase the risk of NEC in the term infants.Cesarean section may be a risk factor for NEC,and further studiesare needed to confirm it.