Campbell Wagemann Stephanie, Mena Nannig Patricia
División de Pediatría, Pontificia Universidad Católica de Chile, Chile.
Unidad de Neonatología, Centro Asistencial Dr. Sotero del Rio, Pontificia Universidad Católica de Chile, Santiago, Chile.
Rev Chil Pediatr. 2019 Jun;90(3):267-274. doi: 10.32641/rchped.v90i3.772.
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.
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.
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.
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.
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.
高胆红素血症在新生儿中极为常见，当胆红素水平高于20至25mg/dl时，存在神经受累风险。这种进展可通过早期检测和治疗来预防。
描述住院的胆红素水平高于20mg/dl的高胆红素血症患者的发病率及相关因素，以及住院期间有症状病例的随访情况。
对2013年至2016年期间患有严重高胆红素血症的患者进行回顾性研究。评估危险因素，按胆红素水平、入院年龄和胎龄进行分层。数据在Excel数据库中采用Fisher精确检验、卡方检验和相对危险度（RR）进行比较，α错误设定为p<0.05。数据取自电子出院小结和二级随访病历。
在研究期间，25288例活产新生儿（NB）中，593例因胆红素水平高于20mg/dl而住院，每42例活产NB中有1例；59例胆红素水平高于25mg/dl，每428例活产NB中有1例。高胆红素血症在男性中更为常见，RR为1.22（95%CI 1.04 - 1.44），与足月儿相比，晚期早产儿中更常见，RR为2.39（95%CI 1.96 - 2.93）。入院超过四天的患者，主要相关因素是体重过度减轻，而在前三天则是典型的血型不合。十例急性脑病患者中有三例持续存在神经受累，即每10万活产中有11.8例。
发生严重高胆红素血症的主要危险因素是早产、体重过度减轻、典型的血型不合和男性。这些发现有助于关注高危人群并降低神经损伤的可能性。
