Y Bao, XY Chen, LP Shi, XL Ma, Z Chen, F Luo, ZY Zhao

Abstract

Purpose: This study delineates the clinical features of near term and term infants with acute bilirubin encephalopathy (ABE) from east China and shares our experience in managing these patients. Methods: This is a retrospective study conducted in a children's hospital in east China. Clinical charts of infants with ABE were reviewed. The data were collected by a detailed questionnaire and analysed. Results: From August 2004 to July 2011, 116 infants assessed to have developed ABE were recorded in this hospital. The infants had a mean birth weight of 3176±453 grams with gestational age of 38.1±1.6 weeks. Seventy infants (60.3%) were males. After admission, the highest bilirubin level was (486.0±169.4) mmol/L. The most common cause of ABE was ABO incompatibility (38, 32.8%), followed by sepsis and infection (14, 12.1%). Phototherapy was performed in 84.5% infants, and exchange transfusion was done in 45 infants (38.8%). Based on clinical bilirubin-induced neurologic dysfunction (BIND) scoring, 14 (12.1%), 83 (71.6%) and 19 (16.4%) infants were classified as subtle, moderate ABE and severe ABE respectively on admission. The severe ABE group had worse short-time outcomes than the subtle and the moderate ABE groups. Conclusions: Neonatal acute bilirubin encephalopathy in term and near-term infants is not a benign entity. It carries fairly high death rate and often leads to significantly poor short-term outcomes. BIND score should be evaluated after admission to evaluate short-time outcomes. Recognition of the whole clinical spectrum and progress of ABE is of paramount importance in the prevention and management of ABE.