Neonatal Unit, Department of Pediatrics, PGIMER, Chandigarh, India.
J Trop Pediatr. 2010 Oct;56(5):333-6. doi: 10.1093/tropej/fmp142. Epub 2010 Feb 1.
The aim of the study was to determine the neurodevelopmental outcome of acute bilirubin encephalopathy (ABE) in children who underwent double volume exchange transfusion (DVET). The 25 referred newborns of ≥ 35 weeks gestation with total serum bilirubin >20 mg dl(-1) and signs of ABE were enrolled and followed up at 3, 6, 9 and 12 months. Denver Development Screening Test (DDST), Neurological examination along with MRI at discharge and brain stem evoked response audiometry (BERA) at 3 months were done. Abnormal neurodevelopment was defined as either (i) cerebral palsy or (ii) abnormal DDST or (iii) abnormal BERA. The mean bilirubin at admission was 37 mg dl(-1). MRI and BERA were abnormal in 61% and 76%. At 1 year, DDST and neurological abnormality were seen in 60% and 27% and 80% had combined abnormal neurodevelopment. MRI had no relation (P = 0.183) but abnormal BERA had a significant association (P = 0.004) with abnormal outcome. Intermediate and advanced stages of ABE associated with significant adverse outcome in spite of DVET.
本研究旨在确定接受双倍容量换血（DVET）的急性胆红素脑病（ABE）患儿的神经发育结局。纳入了 25 名胎龄≥35 周、总血清胆红素>20mg/dl 且有 ABE 迹象的转诊新生儿，并在 3、6、9 和 12 个月时进行随访。在出院时进行丹佛发育筛查测试（DDST）、神经系统检查和磁共振成像（MRI），在 3 个月时进行脑干听觉诱发电位（BERA）。异常神经发育定义为：（i）脑瘫或（ii）DDST 异常或（iii）BERA 异常。入院时的平均胆红素水平为 37mg/dl。61%的患儿 MRI 异常，76%的患儿 BERA 异常。1 岁时，DDST 和神经系统异常分别为 60%和 27%，80%的患儿存在联合异常神经发育。MRI 无相关性（P=0.183），但异常 BERA 与异常结局有显著相关性（P=0.004）。ABE 的中晚期与 DVET 后显著不良结局相关。
