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

摘要：

目的　探讨高胆红素血症新生儿经皮胆红素（TCB）、白蛋白（ALB）、总胆红素/白蛋白（B/A）水平变化及其与远期神经发育的相关性。方法　选取2021年1月至2023年1月西北妇女儿童医院收治的98例高胆红素血症新生儿为观察组，另选取同期在本院出生的90例正常新生儿为对照组。观察组男53例，女45例；胎龄（40.04±1.32）周；日龄（3.57±0.36）d；出生体重（3.40±0.53）kg；分娩方式：剖宫产17例，阴道分娩81例。对照组男55例，女35例；胎龄（39.99±1.41）周；日龄（3.63±0.34）d；出生体重（3.47±0.51）kg；分娩方式：剖宫产18例，阴道分娩72例。检测观察组（治疗前、治疗7 d后）和对照组（纳入研究后次日）TCB、ALB水平，并计算B/A水平。随访12个月，根据神经发育结局将患儿分为不良结局组（12例）和良好结局组（86例）。采用多因素logistic回归分析高胆红素血症新生儿不良结局的影响因素。采用受试者操作特征曲线（ROC）分析TCB、ALB、B/A对高胆红素血症新生儿不良结局的预测效能。采用独立样本t检验、配对t检验和χ²检验进行统计学分析。结果　观察组治疗前TCB、B/A水平均高于对照组［（360.23±35.82）μmol/L比（202.38±21.45）μmol/L、9.87±1.90比4.60±1.84］，ALB水平低于对照组［（30.48±4.23）g/L比（35.04±2.42）g/L］（均P<0.05）。治疗前、治疗7 d后，不良结局组TCB、B/A水平均高于良好结局组［（383.23±39.74）μmol/L比（342.31±23.86）μmol/L、（182.23±22.10）μmol/L比（172.34±9.84）μmol/L、11.92±2.11比8.78±1.49、9.20±1.56比4.84±1.17］，ALB水平均低于良好结局组［（27.92±2.19）g/L比（32.84±2.78）g/L、（31.80±1.62）g/L比（35.13±2.12）g/L］（均P<0.05）。多因素logistic回归分析显示，治疗前TCB、ALB、B/A水平均是高胆红素血症新生儿不良结局的独立危险因素（均P<0.05）。ROC结果显示，治疗前TCB、ALB、B/A水平联合检测的曲线下面积大于治疗前TCB、ALB、B/A水平单独预测（均P<0.05）。结论　高胆红素血症新生儿TCB、B/A水平升高，ALB水平降低。治疗前TCB、ALB、B/A水平均是高胆红素血症新生儿不良结局的独立危险因素，且联合检测效能较高。

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