ABSTRACT
Objective:To investigate the prognosis of severe hyperbilirubinemia in full-term infants who met the exchange transfusion criteria and were treated by blood exchange transfusion and phototherapy.Methods:A total of 168 full-term infants with severe hyperbilirubinemia who met the criteria for exchange transfusion and were hospitalized in the Neonatology Department of seven tertiary hospitals in Hebei Province from June 2017 to December 2018 were retrospectively included. According to the treatment protocol, they were divided into two groups: exchange transfusion group (38 cases) and phototherapy group (130 cases). Two independent sample t-test and Chi-square test were used to compare the clinical manifestations and follow-up results between the two groups. Multivariate logistic regression was used to analyze the risk factors for poor prognosis. Results:Neonatal severe hyperbilirubinemia in the exchange transfusion and phototherapy group were both mainly caused by hemolytic disease [42.1%(16/38) and 29.2%(38/130)], sepsis [28.9%(11/38) and 11.5%(15/130)] and early-onset breastfeeding jaundice [15.8%(6/38) and 11.5%(15/130)]. Total serum bilirubin level on admission in the exchange transfusion group was significantly higher than that in the phototherapy group [(531.7±141.3) vs (440.0±67.4) μmol/L, t=3.870, P<0.001]. Moreover, the percentage of patients with mild, moderate and severe acute bilirubin encephalopathy in the exchange transfusion group were higher than those in the phototherapy group [15.8%(6/38) vs 3.8%(5/130), 7.9%(3/38) vs 0.8%(1/130), 13.2%(5/38) vs 0.0%(0/130); χ2=29.119, P<0.001]. Among the 168 patients, 135 were followed up to 18-36 months of age and 12 showed poor prognosis (developmental retardation or hearing impairment) with four in the exchange transfusion group (12.9%, 4/31) and eight in the phototherapy group (7.7%, 8/104). Multivariate logistic regression analysis showed that for full-term infants with severe hyperbilirubinemia who met the exchange transfusion criteria, phototherapy alone without blood exchange transfusion as well as severe ABE were risk factors for poor prognosis ( OR=14.407, 95% CI: 1.101-88.528, P=0.042; OR=16.561, 95% CI: 4.042-67.850, P<0.001). Conclusions:Full-term infants who have severe hyperbilirubinemia and meet the exchange transfusion criteria should be actively treated with blood exchange transfusion, especially for those with severe ABE, so as to improve the prognosis.
ABSTRACT
Objective To investigate the influence of combined drug therapy by intratracheal infusion on clinical prognosis of premature infants with severe respiratory distress syndrome (RDS). Methods One hundred and twenty-eight premature infants with severe RDS were chosen in the period from August 2015 to December 2017 in central hospital of Hebei Handan and randomly divided into 2 groups including control group (64 children) treated with pulmonary surfactant (PS) by intratracheal infusion and experimental group (64 children) treated with PS and budesonide by intratracheal infusion. The invasive ventilation time, withdrawal time, total hospitalization time, the levels of blood oxygen index before and after treatment and the complications incidence of two groups were compared. Results The invasive ventilation time, withdrawal time and total hospitalization time in experimental group were significantly shorter than those in control group:(3.50 ± 0.72) d vs.(4.84 ± 0.98) d, (29.52 ± 3.97) d vs. (35.21 ± 5.10) d, (45.26 ± 6.27) d vs. (53.85 ± 8.04) d, and there were significant differences (P<0.05). The levels of blood oxygen index after treatment of experimental group were significantly better than those of control group (P < 0.05). The incidence of total bronchopulmonary dysplasia(BPD), retinopathy, necrotizing enterocolitis, pulmonary hemorrhage, sepsis, intracranial hemorrhage and ventilator-associated pneumonia (VAP) in two groups had not significant differences (P>0.05). But the moderate to severe BPD in experimental group was significantly lower than that in control group: 15.63％(10/64) vs. 45.31％(29/64), P < 0.05. Conclusions Combinated drug therapy by intratracheal infusion in the treatment of premature infants with severe RDS can efficiently promote disease recovery process, improve the lung function and be helpful to prevent the moderate and severe degree BPD.