Table of Contents

HK J Paediatr (New Series)
Vol 18. No. 2, 2013

HK J Paediatr (New Series) 2013;18:82-88

Original Article

Clinical Features of 116 Near Term and Term Infants with Acute Bilirubin Encephalopathy in Eastern China
116名急性膽紅素腦病近足月和足月華東地區嬰兒的臨床特徵

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.

目的:本研究描述華東地區近足月和足月兒急性膽紅素腦病(ABE)的臨床特點,並分享我們處理這些病人的經驗。方法:這是一項在華東地區兒童醫院進行的回顧性研究。審閱患有ABE嬰兒的病歷,以詳細問卷收集數據進行調查和分析。結果:從2004年8月至2011年7月,在這醫院共有116名患有ABE的嬰兒。嬰兒的平均出生體重為3176?53克,胎齡38.1?.6周。70人(60.3%)為男性。入院後,最高膽紅素水平為(486.0?69.4)mmol/ L,ABE的最常見原因是ABO血型不合(38,32.8%),其次是敗血症和感染(14,12.1%)。84.5%的嬰兒接受了光療,和45例(38.8%)換血。入院時按臨床膽紅素誘導的神經功能障礙(BIND)評分,把ABE嬰兒分為輕度:14人(12.1%),中度:83人(71.6%)和嚴重:19人(16.4%)。嚴重ABE組比輕度組和中度組的結果差。結論:新生兒急性膽紅素腦病在近足月和足月兒都不是一種良性的現象。它的死亡率相當高,往往會導致顯著較差的短期結果。入院後應使用BIND評分評估短期狀況。識別ABE的整個臨床情況和進度,對預防和管理ABE是非常重要的。

Keyword : Acute bilirubin encephalopathy; Bilirubin-induced neurologic dysfunction; Infant; Newborn

關鍵詞:急性膽紅素腦病、膽紅素誘導的神經功能障礙、嬰兒、新生兒

 
 

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