A Study Of Short-term Neurological Outcome Evaluation In Severe Neonatal Hyperbilirubinemia Infants Requiring Exchange Transfusion

Objective: The present study was designed and conducted to compare the clinical characteristics and short-term neurological outcome using Neonatal Behavioral Neurology Assessment(NBNA)between exchange transfusion(ET)group and non-ET group of neonatal hyperbilirubinemia,to provide a reference for reducing the implementation rate of ET.Methods: This retrospective study was performed using data from Childrens’ Hospital of Chongqing Medical University in China from January 2015 to December 2019.Peak total serum bilirubin(TSB)of all infants reached the standard of ET at admission.Neonates who reached the standards of ET were divided into non-ET group and ET group,respectively.General conditions,treatment effects,the incidences of ABE and NBNA score were recorded and analyzed.(1)Determine risk factors of NBNA<35 by binary logistic regression.(2)Propensity score matching(PSM)was used to match all confounding factors of the two groups to analyze the NBNA scores.Results:(1)A total of 598 infants were admitted for neonatal hyperbilirubinemia were analyzed;of these,393 with mean peak TSB of434.5(401.0,477.7)umol /L refused ET,and 205 infants with mean peak TSB of 510.7 ± 126.1 umol/L received ET,the difference between the two groups was 76.2 umol/L.The ratios of NBNA<35 in the two groups were22.1% and 38.0%,respectively.Binary logistic regression analysis shows that gestational age and ET were independent risk factors for NBNA < 35(P< 0.05).(2)After the propensity score matching,128 pairs were successfully matched.Comparing with ET group,the incidence of NBNA score < 35 in non-ET group was lower(16.4% vs 36.7%,P<0.05),especially in the subgroup of non-ABE group and subtle-ABE group.Moreover,there were no significant difference between the two groups in brainstem auditory evoked potentia(BAEP)and magnetic resonance(MRI).The decrease of TSB in ET group was higher than that in non-ET group,and hospital stay was longer(P<0.05).No death was observed in the two groups.Conclusion: In newborns with severe hyperbilirubinemia whose TSB meeting the criteria for ET,especially if the neonates have no or only mild ABE clinical symptoms,the risk of short-term nerve injury in children who choose non-ET treatment might be lower.Whether to choose ET still need to be carefully considered.