Total serum bilirubin and bilirubin to albumin values in predicting neonatal acute bilirubin encephalopathy: a multicenter study / 中国新生儿科杂志

Objective:To study the predictive value of total serum bilirubin (TSB) and the ratio of bilirubin to albumin (B/A) in neonatal acute bilirubin encephalopathy (ABE).Methods:Neonates with extremely severe hyperbilirubinemia (TSB≥425 μmol/L) treated in the Nanjing Maternal and Child Health Hospital, Maternity and Child Health Care of Guangxi Zhuang Autonomous Region, Northwest Women and Children's Hospital, Yinchuan Maternal and Child Health Hospital and Liaocheng People's Hospital from March 2018 to August 2019 were selected as prospective subjects for this study. According to the score of brain injury induced by bilirubin, the subjects were divided into ABE group and non-ABE group, and the predictive value of TSB peak and B/A for neonatal ABE were analyzed.Results:A total of 194 infants with extremely severe hyperbilirubinemia were recruited in this study, including 20 in ABE group and 174 in non-ABE group. The peak value of bilirubin ranged from 427 to 979 μmol/L. The optimal critical values of TSB peak value and B/A for ABE prediction were 530 μmol/L and 9.48, respectively. The sensitivity and specificity of ABE prediction were 85.0% and 92.8% when combined with TSB peak and B/A values.Conclusions:TSB peak combined with B/A value can effectively identify neonatal ABE. When the TSB peak value was greater than 530 μmol/L and the B/A value was greater than 9.48, the neonates had a higher risk of neonatal ABE.

Analysis of influencing factors of acute bilirubin encephlopathy in neonates with severe hyperbilirubinemia / 中国小儿急救医学

Objective:To explore the influencing factors of acute bilirubin encephalopathy (ABE) in neonates with severe hyperbilirubinemia.Methods:A total of 123 cases of severe neonatal hyperbilirubinemia (serum total bilirubin > 342 μmol/L) in our hospital from January 2018 to May 2020 were retrospectively analyzed.According to the occurrence of ABE, they were divided into ABE group (28 cases) and non-ABE group (95 cases). The perinatal data and laboratory examination results between two groups were compared.The variables with statistical differences in univariate analysis were included in multivariate Logistic regression analysis.Results:Univariate analysis showed that the hemoglobin level and hematocrit of ABE group were higher than those of non-ABE group.The total bilirubin value, length of hospital stay, natural childbirth, mixed feeding, infection with craniocerebral hemorrhage were all higher than those in the non-ABE group, and the differences were statistically significant( P<0.05). Multivariate Logistic regression analysis showed that high hemoglobin level ( OR=1.032, 95% CI 1.007 to 1.057) and long hospital stay ( OR=1.15, 95% CI 1.007 to 1.312) were independent risk factors for ABE patients.Breastfeeding was a protective factor for ABE patients( OR=0.151, 95% CI 0.028 to 0.821). Conclusion:High hemoglobin value and long hospital stay are independent risk factors for ABE patients, and breast feeding is a protective factor for ABE.

Early hospital discharge and readmission jaundice in term babies

Background: Hyperbilirubinemia is a common and often benign disease in the neonatal period. It is the most common cause of readmission in early neonatal period. Prolonged hyperbilirubinemia can result in chronic bilirubin encephalopathy. Increasing the hospital stay of otherwise healthy neonates is not an acceptable solution for medical, social and economic constraints. So, identifying the risk factors for readmission assumes importance. Aim of our study is to identify the risk factors for readmission jaundice in our hospital.Methods: In this study, authors used a questionnaire to find out the risk factors for readmission in those babies who were readmitted with jaundice within 3 weeks of life to our hospital. During the study period, routine treatment practices were followed and there was no deviation from the standard of care for the purpose of research.Results: Of the 2297 deliveries during this study period, 93 babies (4%) were readmitted with jaundice.Among the 93 babies, prevalence of blood group incompatibility was one of the common causes of neonatal jaundice. 46.2% of the babies had an early discharge. Total Serum bilirubin levels were measured by a hospital-based bilirubin assay. Babies with serum bilirubin level above photozones as per American Academy of Pediatrics practice guidelines 2004 were identified and subjected to photo therapy. All the babies in this study responded to photo therapy. No other interventions were needed.Conclusions: Though an early discharge is the most cost-effective strategy in this era of high medical expenditure, we can identify certain high-risk babies, prone for readmission. Blood group incompatibility, infants of primiparous mothers and GDM mothers are more prone to readmission jaundice. Identifying these high-risk babies and educating the mothers is a more cost-effective strategy than prolonging the hospital stay for all babies.

The clinical significance of globus pallidus MRI signal intensity in the early identification of neonatal bilirubin encephalopathy / 中国新生儿科杂志

Objective To study the clinical significance of globus pallidus signal intensity and the intensity ratio of globus pallidus and putamen (G/P ratio) on magnetic resonance T1WI for the early recognition of neonatal bilirubin encephalopathy.Method From January to December 2017,full-term neonates with hyperbilirubinemia admitted to the neonatology department of our hospital were enrolled in the case group,and full-term neonates without hyperbilirubinemia in the control group.The clinical data,globus pallidus T1WI signal intensity,G/P ratio and the follow-up data were collected.According to the level of hyperbilirubinemia,the neonates in the case group were further assigned into mild hyperbilirubinemia group (serum bilirubin:222 to ＜256 μmol/L),moderate hyperbilirubinemia group (serum bilirubin:256 to ＜342 μmol/L),and severe hyperbilirubinemia group (serum bilirubin:≥ 342 μmol/L).According to the injury score of ABE,the neonates with ABE were assigned into mild ABE group,moderate ABE group and severe ABE group.The correlation of globus pallidus T1WI and T2WI signal values,G/P ratio and the serum bilirubin level and ABE degree were analyzed;receiver operating characteristic (ROC) curve was drawn to explore the predictive value of the T1WI signal value and G/P ratio for the diagnosis of ABE;the changes of globus pallidus T1WI and T2WI signal values during the first 6 months after birth and the results of follow-up to 1 year after discharge were also analyzed.Result A total of 175 neonates were included in the case group (65 in the mild hyperbilirubinemia group,71 in the moderate hyperbilirubinemia group and 39 in the severe hyperbilirubinemia group) and 43 neonates in the control group.39 neonates were diagnosed as ABE (21 mild ABE,12 moderate ABE,and 6 severe ABE).The first T1WI signal value and G/P ratio of neonates in the severe hyperbilirubinemia group was higher than the moderate hyperbilirubinemia group,the mild hyperbilirubinemia group and the control group;the T1WI signal value and G/P ratio in the moderate hyperbilirubinemia group was higher than the mild hyperbilirubinemia group and the control group (P ＜ 0.05).No significant difference existed between the mild group and the control group(P ＞ 0.05).T2WI values showed no differences among neonates with different bilirubin levels (P ＞ 0.05).The first T1WI signal value and G/P ratio in the severe ABE group were significantly higher than the moderate and mild ABE group,and the moderate ABE group higher than the mild ABE group (P ＜ 0.05).The ROC curve indicated the optimal cut-off value of T1WI signal and G/P ratio were 628 and 1.38,respectively.Among all the 175 neonates,9 had a decrease in T1WI signal value and an increase in T2WI signal value at 6 months after birth.After 1 year of follow-up visits,7 children were finally diagnosed as chronic bilirubin encephalopathy.All these children had increased signal intensity on T1WI in the acute phase,plus a decreased T1WI signal and an increased T2WI signal in 1 ～ 6 months after birth.Conclusion The globus pallidus T1WI signal and G/P ratio are closely related to the serum bilirubin level and ABE severity.If T1WI signal value ＞ 628 or G/P value ＞ 1.38,ABE should be considered.The T1WI signal value and G/P ratio play important roles as indicators for the early recognition of neonatal bilirubin encephalopathy.

Living related donor liver transplantation for infant with Crigler-Najjar syndrome type Ⅰ: a report of one case and literature review / 器官移植

Objective To summarize the therapeutic effects of living related donor liver transplantation for Crigler-Najjar syndrome type Ⅰ (CNS type Ⅰ). Methods A 3-month-old male infant had appeared a progressive xanthochromia of the skin and sclera 4 d after birth without obvious cause. Other causative factors were eliminated after relevant tests were completed, and identified as CNS type Ⅰ by genetic testing. Living related donor liver transplantation was performed with his mother as the donor. An immunosuppression regimen was routinely applied postoperatively and tacrolimus doses were adjusted according to biochemical indicators and cytochrome P450 (CYP) 3A5 genotype of the recipient. Results The liver enzymes of the recipient returned to normal at 7 d postoperatively, and bilirubin decreased daily and fell to the normal range at 22 d postoperatively. Followed up to the submission date, the recipient's xanthochromia of skin and scleral faded with normal bilirubin and stable liver enzymes. The condition of the recipient was generally good with high quality of life. Conclusions Living donor liver transplantation can treat unconjugated hyperbilirubinemia and other diseases caused by CNS type Ⅰ, which greatly improve the quality of life of patients.

Clinical profiles and outcomes of neonates with neonatal hyperbilirubinemia and treated with double volume exchange transfusion: a retrospective study

Background: Double volume exchange transfusion (DVET) for severe unconjugated hyperbilirubinemia has become less common events now days in pediatric practices. But kernicterus is still common in low income country like India. The aim of the study was to determine the clinical profile and outcome in neonates who were treated with DVET.Methods: This was a retrospective study in neonate's ?34 weeks of gestation that were treated with DVET for severe neonatal hyperbilirubinemia over a period of four years.Results: In our study, 37 neonates underwent DVET. Male neonates (62.13%) and normal vaginal delivery (NVD) (70.2%) are common. ABO Isoimmunisation was commonest cause (56.75%) of exchange transfusion.' The mean TSBR at pre exchange and Post Exchange were 27.39 ' 5.99mg/dl and 15.16 ' 4.00mg/dl (p<0.05). Ten neonates (27%) among 37 neonates required twice DVET.Thrombocytopenia14 (37.83%); Seizure 5(13.5%) and Hypocalcaemia 3(8.1%) were common complication noted among total 17 (45.94%) neonates. BIND occurred in 15 neonates (40.5%) at the time of admission and seven (18.9%) neonates had persistent neurological abnormality at discharge. Neonate with BIND had early onset of jaundice (44.13'15.37 hours vs. 61.22'28.23hrs, p<0.05), with' higher' pre exchange TSBR value(28.96 '8.5mg/dl vs. 26.22'3.17mg/dl). Neonates admitted with BIND had higher percentage of persistent encephalopathy (40% vs. 4.5%,p<0.05), abnormal tone (33.3% vs. 4.5%,p<0.05), abnormal feeding (33.3% vs. 4.5%,p<0.05) and abnormal posture (26.6% vs. 0%,p<0.05)' at discharge as compared to those without BIND. No death occurred in this study population.Conclusions: Early detection and aggressive therapy with DVET can prevent neonates from brain injury.

Hiperbilirrubinemia severa en recién nacidos, factores de riesgo y secuelas neurológicas / Severe hyperbilirubinemia in newborns, risk factors and neurological outcomes

INTRODUCCIÓN: La hiperbilirrubinemia es altamente prevalente en los recién nacidos, con riesgo de compromiso neurológico con bilirrubinemias mayor a 20-25 mg/dl. Esta progresión es prevenible con detección y tratamiento precoz. OBJETIVO: Describir incidencia y factores asociados en pacientes hospitalizados con hiperbilirrubinemia mayor de 20 mg/dl, y el seguimiento de casos sintomáticos durante hospitalización. PACIENTES Y MÉTODO: Estudio retrospectivo de pacientes con hiperbilirru- binemia severa, entre el 2013 y 2016. Se evaluaron factores de riesgo, estratificándose por nivel de bilirrubina, edad de ingreso y edad gestacional. Se compararon los datos con test exacto de Fisher, chi cuadrado y riesgo relativo (RR) en una base de excel, con un error alfa de un p<0.05. Los datos fueron obtenidos a través de la epicrisis electrónica y de la ficha de control a nivel secundarios. RESULTADOS: Durante el periodo, de 25.288 recién nacidos vivos (RNV), 593 se hospitalizaron por hiperbilirrubinemia mayor de 20 mg/dl, 1 por cada 42 RNV; y 59 con bilirrubinemia mayor a 25 mg/dl, 1 por cada 428 RNV. La hiperbilirrubinemia fue más frecuente en varones, con RR 1,22 (IC 95% 1,04-1,44) y en pretérminos tardíos, con un RR 2,39 (IC 95% 1,96-2,93) comparado con RN de término. En los ingresados con más de 4 días, el principal factor asociado fue la baja de peso excesiva, y en los primeros 3 días, la incompatibilidad de grupo clásico. Tres de 10 pacientes con encefalopatía aguda, persistieron con compromiso neurológico, lo que significa 11,8 por 100.000 nacidos vivos. CONCLUSIONES: Los principales factores de riesgo para desarrollar hiperbilirrubinemia severa fueron prematurez, baja de peso excesiva, incompatibilidad de grupo clásico y sexo masculino. Estos hallazgos permiten focalizar la atención en grupos de riesgo y disminuir la probabilidad de daño neurológico.

INTRODUCTION: Hyperbilirubinemia is highly prevalent in newborns, with risk of neurological invol vement with bilirubinemia higher than 20 to 25 mg/dl. This progression is preventable with early de tection and treatment. OBJECTIVE: To describe the incidence and associated factors in hospitalized pa tients with hyperbilirubinemia higher than 20 mg/dl, and the follow-up of symptomatic cases during hospitalization. OATIENTS Y METHOD: Retrospective study of patients with severe hyperbilirubine mia, between 2013 and 2016. Risk factors were evaluated, stratifying by bilirubin level, admission age, and gestational age. The data were compared with Fisher's exact test, chi-square test, and relative risk (RR) in an Excel database, with an alpha error of p <0.05. The data were obtained from the electronic discharge summary and the medical record of secondary level follow-up. RESULTS: During the studied period, out of 25,288 live newborns (NB), 593 were hospitalized due to hyperbilirubinemia higher than 20 mg/dl, one per each 42 live NB; and 59 with bilirubinemia higher than 25 mg/dl, one per each 428 live NB. Hyperbilirubinemia was more frequent in males, with RR 1.22 (95% CI 1.04-1.44), and in late preterm newborns, with RR 2.39 (95% CI 1.96-2.93) compared with term NB. In those admitted with more than four days, the main associated factor was excessive weight loss, whereas in the first three days was classic group incompatibility. Three of ten cases with acute encephalopathy persisted with neurological involvement, which means 11.8 per 100,000 live births. CONCLUSIONS: The main risk factors for developing severe hyperbilirubinemia were prematurity, excessive weight loss, classic group incompatibility, and male sex. These findings allow to focus attention on risk groups and decrease the probability of neurological damage.

Acute bilirubin encephalopathy in term neonates: a hospital-based study

Background: Acute Bilirubin Encephalopathy and kernicterus is an important cause of cerebral palsy, developmental delay and hearing impairment in low-middle income countries. Interventions such as universal screening for neonatal jaundice, Rhesus immunoglobulins, intensive phototherapy and exchange transfusion have made kernicterus rare in high income countries, but in our set up such cases continue to be reported.  Methods: Retrospective observational study where case records of term neonates brought to the neonatal ICU with signs and symptoms of acute bilirubin encephalopathy during the years 2016 and 2017 were sought and analysed.Results: A total of ten term babies reported to the neonatal unit with severe hyperbilirubinemia along with signs and symptoms of bilirubin encephalopathy of which 60% were females. 90% had a birth weight of more than 2.5 kg and mean birth weight was 2.7±0.25 kgs. All the babies were out born. A 4 babies were born at home of which 3 pregnancies were completely unsupervised during the antenatal period. 90% of the babies were from the rural areas, 6 of the cases were from the districts Rajouri, Poonch and Reasi where the terrain is hilly, 2 from rural areas of Jammu and 1 from Kathua. Only 1 was from the Jammu city. The age at admission ranged from 3-9 days and serum bilirubin from 24 to 43.3 mg %. A 5 babies had ABO incompatibility, 1 Rh incompatibility, 1 sepsis, while no cause could be found in 3.Conclusions: Neonatal jaundice is often not easily appreciated by mothers and caregivers in the home setting until it becomes severe enough, at which point neurological damage may have already occurred. There is an urgent need to train the primary health care personnel in assessment and early identification of risk factors for severe neonatal hyperbilirubinemia. They can help the families to seek prompt treatment for this preventable cause of cerebral palsy and mental retardation.

A clinical study on the effects of exchange transfusion and intensive phototherapy on neurodevelopment in neonates with severe hyperbilirubinemia / 中国新生儿科杂志

Objective To study the effects of exchange transfusion(ET) and intensive phototherapy (IPT) on neurodevelopment in neonates with severe hyperbilirubinemia reaching ET criteria.Method From January 2015 to March 2016,neonates with severe hyperbilirubinemia reaching ET criteria with gestational age ≥35 weeks,and hospitalized in the Department of Neonatology of our hospital were enrolled in the study.The parents were informed of the risks of acute bilirubin encephalopathy (ABE) and both the advantages and disadvantages of IPT and ET.Based on the different choices of their parents,the neonates were assigned into the ET group and the IPT group.General conditions,treatment effects,the incidences of ABE and the prognosis were recorded and analyzed.Result A total of 335 patients were included in this study,147 in the ET group and 188 in the IPT group.Before intervention,the peak of total serum bilirubin (TSB) in ET group (475.8± 100.6 μmol/L) was higher than IPT group (398.3±39.8 μmol/L) (the difference of TSB between two groups was 77.4 μmol/L,P＜0.001),and the incidences of high risk factors such as blood incompatibilities,sepsis,cranial hematoma and intracranial hemorrhage in ET group were higher than IPT group (P＜0.05).Compared with at admission,the incidence of ABE in the ET group increased from 32.0％ to 34.0％ at discharge,mainly due to moderate and severe ABE (the ratio of moderate ABE increased from 2.7％ to 10.2％,and severe ABE increase from 2.7％ to 4.8％).Statistically significant differences existed in the proportion of ABE with different severity at admission and discharge in ET group (P＜0.05),while that in IPT group wasn't statistically significant.241 patients were followed up (follow-up rate 71.9％),with the age ranging from 20 to 36 months.6 cases (5.7％,6/106) in the ET group showed hearing disorder while none (0％,0/135) in the IPT group (P＜0.05).The incidences of neuromotor dyskinesia,language development disorder and spasm in ET group were higher than IPT group(7.5％ vs.3.7％,3.8％ vs.1.5％,4.7％ vs.4.4％,respectively),but the differences weren't statistically significant(P＞ 0.05).No deaths were observed in both groups.Conclusion In neonates with severe hyperbilirubinemia whose TSB exceeding the upper limit of current ET criteria (and within upper limit+5 mg/dl),if the neonates have no risk factors nor clinical symptoms of moderate or severe ABE,only IPT and without ET does not increase the incidence of unfavourable prognosis of central nervous system.

Usefulness of the unbound serum bilirubin for predicting neonatal bilirubin encephalopathy / 国际儿科学杂志

Bilirubin encephalopathy is still one of the challenges for neonatal society.In recent years,the incidence in Europe and North America is 1/100 000 ～ 1/40 000,while it is 1.13‰ in China.The current guideline for neonatal hyperbilirubinemia is based on total serum bilirubin (TSB),combined with gestational age,birth weight,age and risk factors.TSB is used as a main index for phototherapy and exchange transfusion.However,only unbound serum bilirubin (UB) can cross blood brain barrier and neuron membrane to cause neurotoxicity,so it is important to monitor UB.In view of the difficulties to measure UB directly,it has been proposed to measure serum albumin (SA),the TSB/SA ratio,TSB/SA molar ratio and the affinity of SA for TSB in addition to monitor TSB,but their clinical practice value is limited.Previously,the methods for direct detection of UB such as oxidase method,modified peroxidase method and photometric method have not been accepted nor routinely used.Recently Martelanc has piloted to use high performance liquid chromatography to directly measure UB with precision up to pmol/L.This recent progress offers reference for measuring UB in neonates,but the threshold of UB predicting bilirubin encephalopathy needs to be further studied.This article will review the important role of UB in predicting bilirubin encephalopathy,predicting experimental parameters of neonatal bilirubin encephalopathy,current methodologies for direct detection of UB.

Mechanism of regional selective brain damage in neonatal bilirubin encephalopathy / 国际儿科学杂志

Neonatal bilirubin encephalopathy is a common clinical neonatal disease.Brain damage caused by hyperbilirubinemia endangers children's lives or causes permanent neurological sequelae,which seriously affects children's health.It has been evidenced that the pathogenesis of neonatal bilirubin encephalopathy is related to changes in neurotoxicity,brain metabolism,neurotransmitters,immunity and glial cells caused by unconjugated bilirubin.Brain injury induced by unconjugated bilirubin has regional selectivity,which plays an important role in the pathogenesis of neonatal bilirubin encephalopathy and bilirubin brain injury.This article reviews the mechanism of regional selective brain damage in neonatal bilirubin encephalopathy.

Risk factors of acute bilirubin encephalopathy in neonates with severe hyperbilirubinemia / 中国新生儿科杂志

Objective To study the risk factors of acute bilirubin encephalopathy (ABE) in neonates with severe hyperbilirubinemia (total serum bilirubin ≥ 427.5 μmol/L).Method Clinical information of neonates with severe hyperbilirubinemia admitted to the Neonatal Department of Baoan Maternal and Child Health Hospital in Shenzhen from December 2013 to October 2017 were collected.The enrolled cases were grouped as ABE and the control group (without ABE).The risk factors for ABE were compared between the two groups and the Logistic regression analysis was used to evaluate the independent risk factor.Result A total of 104 neonates were recruited.There were 32 cases in the ABE group and 72 cases in the control group.The level of total serum bilirubin and indirect bilirubin,the ratio of total bilirubin/albumin,the incidence of glucose-6-phosphate dehydrogenase deficiency and metabolic acidosis and sepsis,the rate of using traditional Chinese medicine and the failure of treatment in other hospitals and non-resident population were all significantly higher in the ABE group than the control (P ＜ 0.05).Logistic regression analysis showed that total serum bilirubin (OR =1.013,95％ CI 1.007 ～ 1.020) and sepsis (OR =6.343,95％ CI 1.801 ～22.338) were the independent risk factors for ABE.Conclusion The severe hyperbilirubinemia infants,particularly with sepsis,are at higher risk of developing acute bilirubin encephalopathy.

The effects of LED blue light tube phototherapy in the treatment of acute bilirubin encephalopathy / 中国新生儿科杂志

Objective To study the clinical efficacy of LED blue light tube phototherapy in severe hyperbilirubinemia with acute bilirubin encephalopathy (ABE).Method Clinical data of newborns admitted to neonatal department of our hospital between Dec.2013 and Dec.2016 were retrospectively reviewed.Infants with gestational age ≥ 35 weeks who were diagnosed with severe hyperbilirubinemia and ABE were collected and analyzed.From Dec.2013 to Nov.2014,infants treated with common blue light tube were assigned into traditional blue light group (traditional group).From Dec.2014 to Dec.2016,infants treated with LED blue light tube were assigned to LED blue light group (LED group).Total serum bilirubin (TSB) levels and bilirubin induced neurological dysfunction (BIND) scores were analyzed between the two groups.Neuron specific enolase (NSE) levels before and after phototherapy were also compared.Follow-up data for three months after discharge were analyzed.Result Fifty-one infants with severe hyperbilirubinemia and ABE were included,with 24 cases in traditional group and 27 cases in LED group.There were no significant differences in TSB levels and BIND scores between the two groups before phototherapy (P ＞ 0.05).TSB levels at 4 h,24 h and 48 h after phototherapy in LED group were significantly lower than traditional group respectively [(331.3 ±21.8) μmol/L vs.(372.1 ±25.2) μmol/L,(233.6 ± 20.4) μmol/L vs.(269.4 ± 19.8) μmol/L,(184.5 ± 15.2) μmol/L vs.(226.3 ± 22.7) μmol/L,P ＜ 0.05].However,there was no significant difference in TSB levels at 12 h after phototherapy between the two groups (P ＞ 0.05).BIND scores at 4 h after phototherapy in LED group were significantly lower than traditional group [(4.0 ± 0.6) vs.(4.7 ± 0.8),P ＜ 0.05].There were no significant differences in BIND scores at other time points after phototherapy between the two groups (P ＞ 0.05).In both groups,serum NSE levels after phototherapy were lower than before phototherapy.Serum NSE level after phototherapy in the LED group was significantly lower than the traditional group (P ＜ 0.05).Total phototherapy duration of the LED group was significantly shorter than the traditional group (P ＜ 0.05).The incidence of exchange transfusion in LED group was significantly lower than traditional group.The incidence of abnormal brainstem auditory evoked potential in LED group were significantly lower than traditional group at 1 month and 3 months after birth (P ＜ 0.05).The proportion of abnormal cranial MRI between the two groups showed no statistical differences (P ＞ 0.05).Conclusion TSB levels and brain injury indicators should be closely monitored and evaluated in infants with severe hyperbilirubinemia and ABE.Active LED blue light phototherapy can rapidly reduce TSB levels,effectively control the progress of ABE,and reduce the ratio of exchange transfusion.Adverse reactions of LED blue light phototherapy are not observed in this study.

Analysis of short-term clinical outcomes in 98 newborns with severe hyperbilirubinemia treated by peripheral arteriovenous synchronous exchange transfusion / 中国小儿急救医学

Objective To study the type of disease,the optimal time and clinical effect of peripheral arteriovenous synchronous exchange transfusion in the treatment of newborns with hyperbilirubinemia. Methods The clinical data of admitted neonates with severe hyperbilirubinemia who received peripheral ar-teriovenous synchronous exchange transfusion were retrospectively analyzed from January 2015 to December 2016. Results Ninety-eight neonates were enrolled and the mean gestational age was(38. 7 ± 1. 2)weeks,the mean birth weight was(3275. 1 ± 483. 7) grams,76 cases were term infants,20 cases were preterm infants and 2 cases were post term infants. The causes of hyperbilirubinemia included 39 cases of ABO incompatibili-ty(39. 8％),16 cases of Rh incompatibility(16. 3％),3 cases of C3d incompatibility(3. 1％),2 cases of infection(2. 0％),2 cases of cranial hematoma(2. 0％),2 cases of adrenal hematoma(2. 0％) and 34 cases of unknown hyperbilirubinemia ( 34. 7％) . The mean age of exchange transfusion was ( 5. 8 ± 4. 4 ) days. Exchange transfusion removed 45. 0％ of total body bilirubin. After exchange transfusion,the total serum bili-rubin,platelet level decreased as compared with those of pre-exchange levels,the differences were statistically significant(t=15. 85,P<0. 05;t=13. 75,P<0. 05). The white blood cell counts and hemoglobin increased, the differences were statistically significant(t=4. 06,P<0. 05;t=4. 41,P<0. 05). A total of 44 cases who had bilirubin encephalopathy were compared to other 54 cases who didn't have bilirubin encephalopathy,there were no significant differences in fetal age, age of onset, bilirubin before and after blood exchange. There were significantly differences at time of exchange transfusion and the grade of hospital which the patient ad-mitted at first time(t=2. 46,P<0. 05;t=6. 15,P<0. 05). Conclusion Hemorrhagic disease is the mostimportant cause of neonatal severe hyperbilirubinemia. Clinical effect of peripheral arteriovenous synchronous exchange transfusion in the treatment of newborns with hyperbilirubinemia is obvious. Timely exchange trans-fusion can reduce the occurrence of bilirubinencephalopathy. For basic-level hospitals,it is still necessary to strengthen the implementation of hour-specific bilirubin to predict the risk of neonatal hyperbilirubinemia.

Hiperbilirrubinemia neonatal, encefalopatía bilirrubínica aguda y Kernicterus: La secuencia sigue vigente en el siglo XXI

Aunque la ictericia afecta a más de la mitad de los neonatos en la primera semana de vida, sólo un grupo de ellos pueden desarrollar hiperbilirrubinemia severa y estar en riesgo de desarrollar encefalopatía bilirrubínica. La afectación neurológica puede presentarse con un cuadro agudo (la encefalopatía bilirrubínica aguda), la cual puede o no progresar a una forma crónica (Kernicterus), o con una constelación de síntomas sensoriales, motores y cognitivos, subagudos o crónicos, dependiendo de la presencia de factores de riesgo que aumentan la susceptibilidad al daño neurológico. La bilirrubina libre interactúa con citoquinas inflamatorias y es la responsable del daño neuronal y de las células de la glía en el sistema nervioso central. A pesar de las diferentes medidas de prevención de hiperbilirrubinemia severa, se siguen reportando casos de Kernicterus sobre todo en países en vías de desarrollo, en algunos de los cuales constituyen un problema de salud pública.

Although jaundice affects more than half of infants in the first week of life, only a few of them develop severe hyperbilirubinemia and are at risk of developing bilirubin encephalopathy. Neurological involvement may occur acutely (acute bilirubin encephalopathy,) which may or may not progress to a chronic form (Kernicterus), or with a constellation of sensory, motor and cognitive, subacute or chronic symptoms, depending on the presence of risk factors that increase susceptibility to neurological damage. Free bilirubin interacts with inflammatory cytokines and is responsible for neuronal and glial cell damage in the central nervous system. Despite different methods to prevent severe hyperbilirubinemia, Kernicterus cases continue to be reported, especially in developing countries, including some where this condition constitutes a public health problem.

Effect of Mild Hypothermia Therapy on Neonatal Bilirubin Encephalopathy:Evaluated with 18F-fluorodeoxyglu-cose Positron Emission Tomography/CT and Amplitude Integrated Electroencephalogram / 中国康复理论与实践

Objective To investigate the clinical effect of mild hypothermia on neonatal bilirubin encephalopathy, and the value of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/CT and amplitude integrated electroencephalogram (aEEG) for diagnosis and evaluation of curative effect. Methods From May, 2013 to December, 2014, 29 newborns with bilirubin encephalopathy were divided into conventional group (n=15) and mild hypothermia group (n=14). The conventional group received conventional therapy, and the other group received mild hypothermia in addition. The aEEG and neuron-specific enolase (NSE) were measured before and after treatment, as well as the glucose metabolism rate with 18F-FDG PET/CT after treatment. Results The NSE was lower after treatment in both groups (t>9.670, P2.943, P0.640, P<0.05). Conclusion Mild hypothermia therapy could further promote the energy metabolism of brain cells in neonatal bilirubin encephalopathy. 18F-FDG PET/CT and aEEG can be used for early diagnosis and therapeutic evaluation.

Comprehensive evaluation of total serum bilirubin, amplitude integrated electroencephalogram and brainstem auditory evoked potential and in combination on the early diagnosis of neonatal acute biliru-bin encephalopathy by receiver operating characteristic curve / 中国小儿急救医学

Objective To evaluate the levels of total serum bilirubin(TSB),amplitude integrated electroencephalogram(aEEG) monitoring and brainstem auditory evoked potential(BAEP) individually and in combination for the early diagnosis of neonatal acute bilirubin encephalopathy by receiver operating charac-teristic( ROC) curve. Methods Clinical data was retrospectively analyzed. A total of 152 infants were diag-nosed with hyperbilirubinemia,including 119 cases of non-bilirubin encephalopathy group and 33 cases of bil-irubin encephalopathy group. The detection results of peak serum bilirubin,aEEG,BAEP combined with the three methods were determined with ROC curve analysis. Results The areas under ROC curve of TSB lev-el,aEEG,BAEP and in combination were 0. 900,0. 738,0. 767,0. 925,respectively,the corresponding sensi-tivity(specificity) in the cut-off point were 90. 91%(78. 15%),87. 88%(59. 66%),65. 52%(87. 91%), 93. 10%(82. 42%),respectively. It showed that the area under ROC curve of the maximum,the comprehen-sive assessment in diagnostic sensitivity and specificity of the combination of three methods were better than any single detection method by ROC curve. Conclusion The methods of TSB level,aEEG and BAEP play an important role in the diagnosis of neonatal bilirubin encephalopathy,and combination with the three meth-ods can improve the accuracy of diagnosis.

Comprehensive evaluation of total serum bilirubin, amplitude integrated electroencephalogram and brainstem auditory evoked potential and in combination on the early diagnosis of neonatal acute biliru-bin encephalopathy by receiver operating characteristic curve / 中国小儿急救医学

Objective To evaluate the levels of total serum bilirubin(TSB),amplitude integrated electroencephalogram(aEEG) monitoring and brainstem auditory evoked potential(BAEP) individually and in combination for the early diagnosis of neonatal acute bilirubin encephalopathy by receiver operating charac-teristic( ROC) curve. Methods Clinical data was retrospectively analyzed. A total of 152 infants were diag-nosed with hyperbilirubinemia,including 119 cases of non-bilirubin encephalopathy group and 33 cases of bil-irubin encephalopathy group. The detection results of peak serum bilirubin,aEEG,BAEP combined with the three methods were determined with ROC curve analysis. Results The areas under ROC curve of TSB lev-el,aEEG,BAEP and in combination were 0. 900,0. 738,0. 767,0. 925,respectively,the corresponding sensi-tivity(specificity) in the cut-off point were 90. 91%(78. 15%),87. 88%(59. 66%),65. 52%(87. 91%), 93. 10%(82. 42%),respectively. It showed that the area under ROC curve of the maximum,the comprehen-sive assessment in diagnostic sensitivity and specificity of the combination of three methods were better than any single detection method by ROC curve. Conclusion The methods of TSB level,aEEG and BAEP play an important role in the diagnosis of neonatal bilirubin encephalopathy,and combination with the three meth-ods can improve the accuracy of diagnosis.

Early diagnosis of acute bilirubin encephalopathy in the newborn / 中国新生儿科杂志

Objective To investigate the diagnostic correlation and sensitivity of amplitude integrated electroencephalogram (aEEG),brainstem auditory evoked potential (BAEP) and cranial magnetic resonance imaging (MRI) for acute bilirubin encephalopathy (ABE) in the newborn.Method Term and near-term neonates (gestational age ≥ 35 weeks) with hyperbilirubinemia (the level of bilirubin over than 95th percentile) of high and intermediate risk group admitted in the neonatal ward of Guangxi Maternal and Child Health Care Hospital from Jan 2014 to Dec 2015 were recruited retrospectively.The infants were assigned to ABE group and non-ABE group according to the diagnostic criteria of ABE.The clinical data of the newborns were collected and the diagnostic correlation between clinical diagnosis and aEEG,BAEP and cranial MRI were analyzed.The receiver operating characteristic (ROC) curve was adopted to assess the diagnostic efficiency of the peak level of serum bilirubin,aEEG,BAEP and cranial MRI on the early diagnosis of ABE.Result A total of 152 newborns with hyperbilirubinemia were recruited,including 33 cases in the ABE group and 119 cases in non-ABE group.(1) The results of aEEG and MRI were marginally positively correlated with clinical diagnosis of ABE (aEEG:r =0.487,P ＜ 0.001;MRI:r =0.220,P=0.018),while the results of BAEP were closely related to the clinical diagnosis of ABE (r =0.593,P ＜ 0.001);(2) The results of BAEP and MRI on the diagnosis of ABE were positively correlated with those of aEEG (BAEP:r =0.424,P ＜ 0.001;MRI:r =0.307,P ＜ 0.001).(3) The area under the ROC curves for predicting the onset of ABE were 0.899 for the peak level of serum bilirubin,0.767 for BAEP,0.738 for aEEG and 0.590 for MRI.Conclusion There was the correlation on the diagnosis of ABE among the methods of aEEG,BAEP and MRI.The combined diagnosis of the three methods could play a complementary role.The aEEG contributed to the early diagnosis of ABE with high sensitivity.

Effect of simple phototherapy or phototherapy combined with albumin therapy on severe jaundice in full-term neonates / 中国病理生理杂志

AIM:To analyze the effect of non-exchange transfusion therapy, including simple phototherapy or phototherapy combined with albumin therapy, on severe jaundice in full-term neonates.METHODS: The full-term neo-nates (n=110) with serum total bilirubin (TBIL) level over 342 μmol/L recewed simple phototherapy or phototherapy combined with albumin therapy.The changes of serum bilirubin levels and neurological signs of these neonates were ob-served.RESULTS:Serum TBIL and indirect bilirubin ( IBIL) levels in the 2 groups of hospitalized cases significantly re-duced after the first day of treatment and at discharged (P<0.01).The reduced degrees of TBIL and IBIL levels in the neonates given phototherapy combined with albumin therapy were higher than those in the neonates given simple photothera-py.All these neonates did not have bilirubin encephalopathy on admission or at discharged.CONCLUSION:Both simple phototherapy and phototherapy combined with albumin therapy treat severe jaundice effectively and prevent acute bilirubin encephalopathy in full-term neonates.