关键词:

新生儿高胆红素血症, 经皮胆红素测定, 白蛋白, 总胆红素, 危险因素, 预测价值

Abstract:

Objective　To investigate the changes of transcutaneous bilirubin (TCB), albumin (ALB), and total bilirubin/albumin (B/A) levels in neonates with hyperbilirubinemia and their correlations with long-term neurodevelopmental outcomes. Methods　Ninety-eight neonates with hyperbilirubinemia admitted to Northwest Women and Children's Hospital from January 2021 to January 2023 were selected as an observation group, and 90 normal neonates born in our hospital during the same period were selected as a control group. There were 53 boys and 45 girls in the observation group, with gestational age of (40.04±1.32) weeks, age of (3.57±0.36) d, and birth weight of (3.40±0.53) kg, and the delivery methods were cesarean section in 17 cases and vaginal delivery in 81 cases. In the control group, there were 55 boys and 35 girls, with gestational age of (39.99±1.41) weeks, age of (3.63±0.34) d, and birth weight of (3.47±0.51) kg, and the delivery methods were cesarean section in 18 cases and vaginal delivery in 72 cases. The TCB and ALB levels were detected in the observation group (before treatment and after 7 days of treatment) and the control group (the next day after inclusion in the study), and the B/A level was calculated. After 12 months of follow-up, the children were divided into a poor outcome group (12 cases) and a good outcome group (86 cases) according to the neurodevelopmental outcomes. Multivariate logistic regression analysis was used to analyze the influencing factors of adverse neurodevelopmental outcomes of neonatal hyperbilirubinemia. The receiver operating characteristic curve (ROC) was used to analyze the predictive efficacies of TCB, ALB, and B/A for adverse neurodevelopmental outcomes of neonatal hyperbilirubinemia. Independent sample t test, paired t test, and χ² test were used for statistical analysis. Results　The TCB and B/A levels in the observation group before treatment were higher than those in the control group [(360.23±35.82) μmol/L vs. (202.38±21.45) μmol/L, 9.87±1.90 vs. 4.60±1.84], but the ALB was lower than that in the control group [(30.48±4.23) g/L vs. (35.04±2.42) g/L] (all P<0.05). Before and after 7 days of treatment, the TCB and B/A levels in the poor outcome group were higher than those in the good outcome group [(383.23±39.74) μmol/L vs. (342.31±23.86) μmol/L, (182.23±22.10) μmol/L vs. (172.34±9.84) μmol/L, 11.92±2.11 vs. 8.78±1.49, 9.20±1.56 vs. 4.84±1.17], but the ALB was lower than that in the good outcome group [(27.92±2.19) g/L vs. (32.84±2.78) g/L, (31.80±1.62) g/L vs. (35.13±2.12) g/L] (all P<0.05). Multivariate logistic regression analysis showed that pre-treatment TCB, ALB, and B/A levels were independent risk factors for adverse neurodevelopmental outcomes of neonatal hyperbilirubinemia (all P<0.05). ROC results showed that the area under the curve of pre-treatment TCB, ALB, and B/A combined detection was larger than that predicted by TCB, ALB, or B/A alone (all P<0.05). Conclusions　The TCB and B/A levels of neonatal hyperbilirubinemia increased significantly, and the ALB level decreased. The combined detection of TCB, ALB, and B/A had high predictive value for adverse neurodevelopmental outcomes, which should be paid close attention to clinically.

Key words:

Neonatal hyperbilirubinemia, Transcutaneous bilirubin, Albumin, Total bilirubin, Risk factors, Predictive value