A Multicenter Clinical Study Of Severe Neonatal Hyperbilirubinemia In Inner Mongolia

Objective To clarify the treatment of severe hyperbilirubinemia and the etiology of newborns in Inner Mongolia.To explore risk factors for severe hyperbilirubinemia associated with acute bilirubin encephalopathy(ABE).Find out the best predictors of ABE.And the exchange transfusion therapy was evaluated.Provide a basis for timely detection,early diagnosis,and clinical prevention of severe hyperbilirubinemia and ABE.Methods Retrospective collection from January 01,2020 to 31 December 2021 during the clinic in the affiliated medical university hospital of Inner Mongolia,Inner Mongolia autonomous region people’s hospital,the fourth hospital of Baotou city central hospital,ordos city hospital,Hohhot maternal and child health care,Chifeng college affiliated hospital,Chifeng city hospital,Tongliao city hospital,manzhouli town people’s hospital,a total of nine tertiary hospital neonatal children hospitalized case data.The hospitalization,etiology,laboratory examination results and blood transfusion treatment were analyzed.Results1.543 cases of severe hyperbilirubinemia accounted for 3.6% of the total number in the same period,467(86.0%)in the 543 moderate to severe group,52(9.6%)in the extremely severe group,and 24(4.4%)in the risk group.The 81 cases of ABE accounted for 0.54% of the total number of patients admitted in the same period.2.The ratio of postnatal weight loss in severe hyperbilirubinemia was 2.50 ± 0.07%,which was weakly positively associated with hospital stay.(r=0.319,P=0.001<0.05)。3.356(65.6%)children with severe hyperbilirubinemia had a clear etiology.Of the 543 cases,187(34.4%)had unknown etiology,131(24.1%)were perinatal diseases,72(13.2%),71(13.1%),all ABO incompatible hemolysis,31(5.7%)infectious disease,27(4.9%)breast jaundice,14(2.5%)hypothyroidism,7(1.2%)polycythemia,and 3(0.5%)acidosis.4.The latest days of admission and the largest days of peak TSB were observed(P<0.001).The length of hospitalization for two or more diseases and infectious diseases was compared with other group leaders(P <0.05).The group with two or more diseases had the largest and the group with other groups(P <0.001).The feeding time of the same immune hemolysis group was significantly later than that of perinatal disease group,infectious disease group,and breast milk jaundice group(Bonferroni correction adjusted significance value P<0.001,0.04,<0.001 <0.05).5.ABE group compared with ABE non-ABE group in gender,gestational age,birth weight,mode of delivery,maternal age,severe hyperbilirubinemia,IPC,PROM,asphyxia,infectious disease,two or more diseases,hypothyroidism,polycythemia,acidosis without statistical significance(P> 0.05).In the ABE group,milk duration,hospital duration,B / A,peak TSB,peak TSB,and failure of AABR),magnetic resonance imaging(MRI)abnormalities were significantly higher than in the non-ABE group(P <0.001).The non-ABE group was significantly higher than the ABE group in admission weight,obstetric transfer,unknown etiology,and breast milk jaundice(P <0.001).6.Similar immune hemolysis,breastfeeding,total bilirubin(TSB)and peak TSB(P<0.05)were independent risk factors for ABE.7.The predicted ABE at 380.05 μmol/L is 98.8%,sensitivity 74.4%,and the area under ROC is 0.732;at peak TSB(B/A)is 10.45,the predicted ABE sensitivity is 92.6%,specificity78.0% and 0.71;the area under ROC is 0.752,sensitivity 96.3% and specificity 78.9%.8.Of the 543 cases,270(49.7%)had met the exchange transfusion standard,and the adverse reactions were 10 thrombocytopenia,4 hypoglycemia,2 acidosis,2 hypocalcemia,and 1 hypokalemia.TSB and indirect bilirubin levels in the serum decreased to 43.92% and43.05% of the baseline levels,respectively.Conclusion1.The admission rate of severe hyperbilirubinemia and ABE in Inner Mongolia was high.2.Among the causes of severe hyperbilirubinemia,the etiology is the most unknown,and the cases with clear etiology are the most perinatal related diseases,followed by two or more diseases.3.Independent immune hemolysis and breastfeeding are independent risk factors for ABE.4 The combined detection of TSB and B / A is more effective in identifying ABE than that of TSB.5.The adverse reactions of exchange transfusion therapy were most commonly thrombocytopenia,and the decrease rate of TSB after exchange transfusion was satisfactory.