Analysis of influencing factors for delayed treatment of neonatal hyperbilirubinemia
Guan Hanzhou, Zhang Tao, Zhang Xinhua, et al
(1.Department of Neonate,Shanxi Provincial Children Hospital, Shanxi, Taiyuan 030013, China; 2.School of Humanities and SocialSciences, Shanxi Medical University, Shanxi, Taiyuan 030013, China; 3.Department of Pediatrics, Peking University First Hospital, Beijing 100034, China)
Abstract: 【Abstract】 Objective To investigate influencing factors for delayed treatment of neonatal hyperbilirubinemia, with the aim of finding a solution to reduce the occurrence of acute bilirubin encephalopathy (ABE). Method From January 2018 to December 2020, the 128 neonates who met the exchange transfusion criteria at admission in the Department of Neonatology, Shanxi Children's Hospital, whowere selected as the research objects. According to the visiting age , they were divided into ≤7 d group (n=88)and >7 d group (n=40). The incidence of ABE and poor prognosis were compared between the two groups.Perinatal factors, feeding patterns, delivery hospital factors, maternal factors, disease factors and residencefactors were analyzed. The t test, χ2 test, Fisher exact probability method and multivariate Logistic regressionanalysis were adopted. Result 128 neonates who met the exchange transfusion criteria accounted for0.87% (128/14 652) of all neonates who required hospitalization. The incidence of ABE in the ≤7 d groupwas lower than that in the >7 d group [31.8% (28/88) vs 80.0% (32/40), χ2=25.637, P<0.001]. All enrolledneonates were followed up to 10-18 months of age. The incidence of adverse prognosis in the ≤7 d groupwas significantly lower than that in the >7 d group [13.3% (11/82) vs 38.1%( 12/31), χ2=8.879, P=0.003].The gestational age [(38.8±1.5) vs (37.9±2.1) weeks, t=2.502, P=0.006] and the proportion of cesareansection [36.4% (32/88) vs 12.5% (5/40), χ2=7.620, P=0.006] ,the proportion of formula feeding [76.1% (67/88)vs 20.0% (8/40), χ2=35.719, P<0.001], the proportion of obstetrical discharge instruction jaundice followupage ≤3 d [83.0% (73/88) vs 5.0% (2/40), P<0.001], the proportion of mothers with college educationor above [81.8% (72/88) vs 42.5% (17/40), χ2=20.067, P<0.001], the proportion of hemolytic jaundice [55.7% (49/88) vs 10.0% (4/40), χ2=23.654, P<0.001], the proportion of jaundice detection methods in the community[58.0% (51/88) vs 27.5% (11/40), χ2=10.212, P=0.001], ≤7 d group were higher than that in the > 7 days group.Multivariate Logistic regression analysis showed that the mothers had high school education or below(OR=15.119, 95%CI: 1.966-116.246, P=0.009), non-hemolytic jaundice (OR=11.602, 95%CI: 1.427-94.322,P=0.022), breast feeding (OR=51.635, 95%CI: 5.968-446.728, P<0.001), follow-up age in dischargeinstructions of obstetrics >3 d (OR=255.857, 95%CI: 16.827-3 890.365, P<0.001), low gestational age(OR=1.768, 95%CI: 1.069-2.924, P=0.026) were the risk factors affecting the timely treatment of children (allP<0.05). Conclusion In order to reduce the incidence of neonatal ABE, it is necessary to monitor the neonatal jaundice after discharge, rationalizing breastfeeding, make the popular science knowledge about jaundice tomore people, strengthen the ability of paediatricians and obstetricians to identify and diagnose high risk factors of hyperbilirubinemia, so as to improve the prognosis.
2023, Vol. 11 
