Zhang Fanhui, Chen Lihua, Shang Shiqiang, Jiang Kewen
Department of Neonatology.
Department of Laboratory, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Medicine (Baltimore). 2020 Feb;99(9):e19364. doi: 10.1097/MD.0000000000019364.
To establish a clinical prediction rule for acute bilirubin encephalopathy (ABE) in term/near-term neonates with extreme hyperbilirubinemia.A retrospective cohort study was conducted between January 2015 and December 2018. Six hundred seventy-three out of 26,369 consecutive neonates with extreme hyperbilirubinemia were enrolled in this study. Data included demographic characteristics, total serum bilirubin (TSB), albumin, bilirubin/albumin ratio (B/A), direct antiglobulin test, glucose-6-phosphate deficiency, asphyxia, sepsis, acidosis. ABE was defined as a bilirubin induced neurological dysfunction score of 4 to 9. We used stepwise logistic regression to select predictors of ABE and devised a prediction score.Of the 673 eligible infants, 10.8% suffered from ABE. Our prediction score consisted of 3 variables: TSB (as a continuous variable; odds ratio [OR] 1.16; 95% confidence interval [CI], 1.02-1.31; logistic coefficient 0.15), B/A (as a continuous variable; OR 1.88; 95% CI, 1.19-2.97; logistic coefficient 0.67), and sepsis (OR 3.78; 95% CI, 1.40-10.21; logistic coefficient 1.19). Multiplying the logistic coefficients by 10 and subtracting 75, resulted in the following equation for the score: Score = 12 × (if sepsis) + 1.5 × (TSB) + 7 × (B/A) - 75. The model performed well with an area under the curve of 0.871.The risk of ABE can be quantified according to TSB, B/A, and sepsis in term/near-term neonates with extreme hyperbilirubinemia.
建立足月儿/近足月儿极重度高胆红素血症急性胆红素脑病（ABE）的临床预测规则。2015年1月至2018年12月进行了一项回顾性队列研究。连续26369例极重度高胆红素血症新生儿中的673例纳入本研究。数据包括人口统计学特征、血清总胆红素（TSB）、白蛋白、胆红素/白蛋白比值（B/A）、直接抗人球蛋白试验、葡萄糖-6-磷酸缺乏症、窒息、败血症、酸中毒。ABE定义为胆红素诱导的神经功能障碍评分为4至9分。我们使用逐步逻辑回归选择ABE的预测因素并设计了一个预测评分。在673例符合条件的婴儿中，10.8%患有ABE。我们的预测评分由3个变量组成：TSB（作为连续变量；比值比[OR]1.16；95%置信区间[CI]，1.02 - 1.31；逻辑系数0.15）、B/A（作为连续变量；OR 1.88；95%CI，1.19 - 2.97；逻辑系数0.67）和败血症（OR 3.78；95%CI，1.40 - 10.21；逻辑系数1.19）。将逻辑系数乘以10并减去75，得到以下评分方程：评分 = 12×（如果患有败血症） + 1.5×（TSB） + 7×（B/A） - 75。该模型表现良好，曲线下面积为0.871。极重度高胆红素血症的足月儿/近足月儿患ABE的风险可根据TSB、B/A和败血症进行量化。
