Abstract
We performed the present study to summarize the recent epidemiological characteristics of bilirubin encephalopathy and assess the role of total bilirubin-albumin ratio in the bilirubin encephalopathy. We retrospectively collected clinical data of 669 neonates with hyperbilirubinemia from the First Affiliated Hospital of Zhengzhou University between January 2015 and July 2018, including 153 neonates belonged to bilirubin encephalopathy and 516 ones were treated as control group. Compared with the control group, those with bilirubin encephalopathy have higher bilirubin-albumin ratio (13.8 ± 3.6 vs. 10.6 ± 2.5, P=0.000). The direct bilirubin and indirect bilirubin level were higher in the case group than that in the control group (P=0.000). On the contrary, the hemoglobin level was lower in the case group than that in the control group (P=0.004). There were no significant differences in gestational age (P=0.510), gender rate (P=0.313), maternal gestational diabetes ratio (P=0.071), natural childbirth ratio (P=0.686), and meconium delay (P=0.091). The results from univariate regression indicated the total bilirubin/albumin ratio was positively associated with bilirubin encephalopathy (odds ratio (OR) = 1.67, 95% confidence interval (CI): 1.59–3.14). The total bilirubin, direct bilirubin, and indirect bilirubin were also related to encephalopathy. After adjusting some potential cofounding factors, the total bilirubin-albumin was still associated with bilirubin encephalopathy. The higher total bilirubin-albumin ratio increased the risk of bilirubin encephalopathy by 23% (OR = 1.23, 95% CI: 1.16–2.48). Our results indicated that the bilirubin-albumin ratio is associated with bilirubin encephalopathy in neonates, and could be a potential predictor.
Highlights
Clinical jaundice is present in the majority of the newborns
We found that there was a positive correlation between bilirubin-albumin ratio level and bilirubin encephalopathy
The early bilirubin metabolism in neonates is characterized by reduced excretion or increased secretion of bilirubin, and the serum bilirubin level is often higher than that of adults, leading to an increasing incidence of hyperbilirubinemia year by year
Summary
Most jaundice are benign, there are still some infants suffering from bilirubin encephalopathy due to the extremely high serum bilirubin level and the development of bilirubin-induced neurologic injury [1,2]. It can be classified as acute bilirubin encephalopathy and chronic bilirubin encephalopathy [3]. The prediction and diagnosis of bilirubin encephalopathy are dependent on the assessment of clinical symptoms, total serum bilirubin, bilirubin to albumin ratio, auditory brainstem response, and magnetic resonance imaging [4,5]. In China, some people used the neonatal behavioral neurological assessment to assess the clinical symptoms, but it was complex and less specific in predicting bilirubin encephalopathy. The total serum bilirubin and License 4.0 (CC BY)
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