Predictive Value Of B/A Value,BAEP Combined With BIND Score For Acute Bilirubin Encephalopathy In Neonates

Objective:To analyze the high risk factors of neonatal acute bilirubin encephalopathy(ABE),and to explore the predictive value of the ratio of bilirubin to albumin(B/A),brainstem auditory evoked potential(BAEP)combined with bilirubin-induced neurological dysfunction score(BIND score)for acute bilirubin encephalopathy.Methods:Children with severe hyperbilirubinemia admitted to the neonatal intensive care unit of Kaifeng City Children’s Hospital from January 2018 to December 2022 were selected for retrospective analysis.According to the diagnostic criteria of acute bilirubin encephalopathy,the subjects were divided into acute bilirubin encephalopathy group(n=36)and non-acute bilirubin encephalopathy group(n=79).The general clinical data,perinatal conditions,etiology and accompanying symptoms of neonatal hyperbilirubinemia,laboratory examination,BAEP and BIND score of the two groups were compared.The single factors with statistical difference were included in multivariate regression analysis,and the correlation between BAEP and B/A value,BIND score,clinical diagnosis of ABE was analyzed.And the predictive value of B/A value,BAEP and BIND score for neonatal acute bilirubin encephalopathy was evaluated by receiver operating characteristics(ROC)curve.Results:1.General clinical data:The differences between the two groups were not statistically significant in terms of gender,birth weight,admission weight,feeding pattern,age at appearance of jaundice,and age at peak bilirubin(P>0.05);the differences in terms of parity,gestational age,and admission age were statistically significant(P<0.05)2.Perinatal condition:The differences in maternal age,gestational diabetes mellitus,intrauterine distress,gestational hypertension and maternal hypothyroidism between the two groups were not statistically significant(P>0.05);the differences in mode of delivery and premature rupture of membranes were statistically significant(P<0.05).3.Etiology and concomitant symptoms of neonatal hyperbilirubinemia:The differences between the two groups were not statistically significant in neonatal ABO hemolytic disease,neonatal RH hemolytic disease,cephalohematoma,erythrocytosis,neonatal asphyxia,adrenal hemorrhage,and neonatal hypoglycemia(P>0.05);the differences in neonatal sepsis,other infections,and acidosis were statistically significant(P<0.05).4.Laboratory tests:The differences between the two groups of children were not statistically significant in hemoglobin and red blood cell pressure(P>0.05);the differences in peak serum totalbilirubin,indirect bilirubin,albumin and B/A value were statistically significant(P<0.05).5.BAEP:The difference in BAEP results between the two groups of children was statistically significant(P<0.05);in terms of BAEP abnormalities,the highest percentage of moderate abnormalities was 41.7%in the ABE group and the highest percentage of mild abnormalities was 10.1%in the non-ABE group.6.BIND score:The difference in BIND score between the two groups of children was statistically significant(P<0.05).7.Multi-factor regression analysis:Multi-factor logistic regression analysis showed that B/A value and BIND score were independent risk factors for the development of acute bilirubin encephalopathy(P<0.05).8.Correlation analysis:Spearman’s rank correlation analysis showed that BAEP was positively and significantly correlated with B/A value(r_s=0.672,P<0.05);BAEP was positively and significantly correlated with BIND score(r_s=0.411,P<0.05);BAEP was positively and significantly correlated with the clinical diagnosis of ABE(r_s=0.562,P<0.05).9.ROC curve:area under the cure(AUC)of B/A value:0.910,sensitivity:88.9%,specificity:84.8%,optimal threshold:10.83;AUC of BAEP:0.776,sensitivity:61.1%,specificity:97.5%,optimal threshold:>2.5;AUC of BIND AUC for the score:0.947,sensitivity:91.7%,specificity:86.1%,best critical value:2.5;AUC for the combination of the three:0.981,sensitivity:94.4%,specificity:96.2%.The AUC of B/A value,BAEP,BIND score and the combination of the three was greater than 0.7,and the AUC area was higher than that of the single index when the three were applied together,and their sensitivity and specificity were higher.Conclusion:1.B/A value and BIND score are independent risk factors for the development of acute bilirubin encephalopathy.2.BAEP and B/A value,BIND score,and ABE clinical diagnosis all have good correlation.3.B/A value,BAEP and BIND score can predict acute bilirubin encephalopathy well,and the predictive value of the combination of the three is higher.