Division of Pediatrics, College of Medicine, Baghdad University and Children Welfare Teaching Hospital Medical City Complex, Bab Al-Muadham, Baghdad, Iraq.
Neonatology. 2011;100(1):57-63. doi: 10.1159/000321990. Epub 2011 Jan 5.
Severe neonatal hyperbilirubinemia, when unmonitored or untreated, can progress to acute bilirubin encephalopathy (ABE). Initiatives to prevent and eliminate post-icteric sequelae (kernicterus) are being implemented to allow for timely interventions for bilirubin reduction.
We report an observational study to determine the clinical risk factors and short-term outcomes of infants admitted for severe neonatal jaundice.
A post-discharge medical chart review was performed for a cohort of infants admitted for management of newborn jaundice to the Children Welfare Teaching Hospital during a 4-month period in 2007 and 2008. Immediate outcomes included severity of hyperbilirubinemia, association of ABE, need and impact of exchange transfusion, and survival. Short-term post-discharge follow-up assessed for post-icteric sequelae.
A total of 162 infants were admitted for management of severe jaundice. Incidences of severe sequelae were: advanced ABE (22%), neonatal mortality within 48 h of admission (12%) and post-icteric sequelae (21%). Among the cohort, 85% were <10 days of age (median 6 days, IQR 4-7 days). Readmission total serum bilirubin ranged from 197 to 770 μM; mean 386 ± 108 SD μM (mean 22.6 ± 6.3 SD mg/dl; median 360, IQR 310-445 μM). The major contributory risk factor for the adverse outcome of kernicterus/death was admission with advanced ABE (OR 8.03; 95% CI 3.44-18.7). Other contributory factors to this outcome, usually significant, but not so for this cohort, included home delivery, sepsis, ABO or Rh disease. Absence of any detectable signs of ABE on admission and treatment of severe hyperbilirubinemia was associated with no adverse outcome (OR 0.34; 95% CI 0.16-0.68).
Risks of mortality and irreversible brain injury among healthy infants admitted for newborn jaundice are urgent reminders to promote education of communities, families and primary health care providers, especially in a fractured health system. Known risk factors for severe hyperbilirubinemia were overwhelmed by the effect of advanced ABE.
严重的新生儿高胆红素血症，如果未监测或未经治疗，可能会发展为急性胆红素脑病（ABE）。为了及时进行胆红素降低干预，正在实施预防和消除核黄疸后遗症（核黄疸）的措施。
我们报告了一项观察性研究，以确定因严重新生儿黄疸住院的婴儿的临床危险因素和短期结局。
对 2007 年和 2008 年期间在儿童福利教学医院因新生儿黄疸管理而住院的一组婴儿进行出院后病历回顾。主要结局包括高胆红素血症的严重程度、ABE 的相关性、换血的必要性和影响，以及存活率。短期出院后随访评估核黄疸后遗症。
共有 162 名婴儿因严重黄疸住院治疗。严重后遗症的发生率为：高级 ABE（22%）、入院后 48 小时内新生儿死亡（12%）和核黄疸后遗症（21%）。该队列中，85%的婴儿年龄<10 天（中位数 6 天，IQR 4-7 天）。再次住院的总血清胆红素范围为 197 至 770μM；平均值 386±108SDμM（平均值 22.6±6.3SDmg/dl；中位数 360，IQR 310-445μM）。核黄疸/死亡不良结局的主要致病危险因素是入院时伴有高级 ABE（OR 8.03；95%CI 3.44-18.7）。其他导致这种结局的致病因素通常很重要，但对本队列来说并非如此，包括家庭分娩、败血症、ABO 或 Rh 疾病。入院时无任何 ABE 可检测迹象且严重高胆红素血症得到治疗与无不良结局相关（OR 0.34；95%CI 0.16-0.68）。
在新生儿黄疸住院的健康婴儿中，死亡率和不可逆性脑损伤的风险迫切需要提醒社区、家庭和初级卫生保健提供者接受教育，特别是在一个支离破碎的卫生系统中。严重高胆红素血症的已知危险因素被高级 ABE 的影响所掩盖。
