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Neuropediatrics 2022; 53(04): 257-264
DOI: 10.1055/s-0041-1742156
Original Article

Outcome Analysis of Severe Hyperbilirubinemia in Neonates Undergoing Exchange Transfusion

Ruili Zhang   #
1   Henan Key Laboratory of Child Brain Injury and Henan Pediatric Clinical Research Center, Institute of Neuroscience and Third Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
,
Wenqing Kang   #
2   Department of Neonatology, Children's Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
,
Xiaoli Zhang   #
1   Henan Key Laboratory of Child Brain Injury and Henan Pediatric Clinical Research Center, Institute of Neuroscience and Third Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
,
Lina Shi
3   Department of Neonatology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
,
Rui Li
2   Department of Neonatology, Children's Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
,
Yanmei Zhao
2   Department of Neonatology, Children's Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
,
Jing Zhang
3   Department of Neonatology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
,
Xiao Yuan
1   Henan Key Laboratory of Child Brain Injury and Henan Pediatric Clinical Research Center, Institute of Neuroscience and Third Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
,
Shasha Liu
1   Henan Key Laboratory of Child Brain Injury and Henan Pediatric Clinical Research Center, Institute of Neuroscience and Third Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
,
Wenhua Li
1   Henan Key Laboratory of Child Brain Injury and Henan Pediatric Clinical Research Center, Institute of Neuroscience and Third Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
,
Falin Xu
1   Henan Key Laboratory of Child Brain Injury and Henan Pediatric Clinical Research Center, Institute of Neuroscience and Third Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
,
Xiuyong Cheng   #
3   Department of Neonatology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
,
Changlian Zhu    #
1   Henan Key Laboratory of Child Brain Injury and Henan Pediatric Clinical Research Center, Institute of Neuroscience and Third Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
4   Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
5   Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
› Author Affiliations Funding This work was supported by the Department of Science and Technology (171100310200), Department of Health (SB201901055) of Henan Province, Swedish Research council (2018–02667), and ALF (ALFGBG-717791).
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Abstract

Objective Severe neonatal hyperbilirubinemia can cause neurological disability or mortality if not effectively managed. Exchange transfusion (ET) is an efficient treatment to prevent bilirubin neurotoxicity. The purpose of this study was to evaluate outcomes in severe neonatal hyperbilirubinemia with ET and to identify the potential risk factors for poor outcomes.

Methods Newborns of ≥28 weeks of gestational age with severe hyperbilirubinemia who underwent ET from January 2015 to August 2019 were included. Demographic data were recorded and analyzed according to follow-up outcomes at 12 months of corrected age. Poor outcomes were defined as death due to bilirubin encephalopathy or survival with at least one of the following complications: cerebral palsy, psychomotor retardation (psychomotor developmental index < 70), mental retardation (mental developmental index < 70), or hearing impairment.

Results A total of 524 infants were eligible for recruitment to the study, and 62 infants were lost to follow-up. The outcome data from 462 infants were used for grouping analysis, of which 398 cases (86.1%) had normal outcomes and 64 cases (13.9%) suffered poor outcomes. Bivariate logistic regression analysis showed that peak total serum bilirubin (TSB) (odds ratio [OR] = 1.011, 95% confidence interval [CI] = 1.008–1.015, p = 0.000) and sepsis (OR = 4.352, 95% CI = 2.013–9.409, p < 0.001) were associated with poor outcomes of hyperbilirubinemia. Receiver operator characteristic curve analysis showed that peak TSB ≥452.9 µmol/L could predict poor outcomes of severe hyperbilirubinemia.

Conclusion Peak TSB and sepsis were associated with poor outcomes in infants with severe hyperbilirubinemia, and peak TSB ≥452.9 µmol/L could predict poor outcomes.

Keywords

acute bilirubin encephalopathy - hyperbilirubinemia - exchange transfusion - cerebral palsy - neurodevelopmental outcomes

Authors' Contributions

C.Z. and R.Z. designed the study. R.Z., W.K., X.Z., L.S., Y.Z., J.Z., X.Y., S.L., W.L., and X.C. were involved in data collection. W.K., F.X., and X.C. supervised the clinical diagnosis, treatment, and evaluation. R.Z. and C.Z. analyzed the data and wrote the paper. All authors read and approved the final manuscript.


# Equal contribution.




Publication History

Received: 21 June 2021

Accepted: 30 November 2021

Article published online:
17 January 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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