A clinical prediction rule for acute bilirubin encephalopathy in neonates with extreme hyperbilirubinemia

Abstract

To establish a clinical prediction rule for acute bilirubin encephalopathy (ABE) in term/near-term neonates with extreme hyperbilirubinemia. A retrospective cohort study was conducted between January 2015 and December 2018. Six hundred seventy-three out of 26,369 consecutive neonates with extreme hyperbilirubinemia were enrolled in this study. Data included demographic characteristics, total serum bilirubin (TSB), albumin, bilirubin/albumin ratio (B/A), direct antiglobulin test, glucose-6-phosphate deficiency, asphyxia, sepsis, acidosis. ABE was defined as a bilirubin induced neurological dysfunction score of 4 to 9. We used stepwise logistic regression to select predictors of ABE and devised a prediction score. Of the 673 eligible infants, 10.8% suffered from ABE. Our prediction score consisted of 3 variables: TSB (as a continuous variable; odds ratio [OR] 1.16; 95% confidence interval [CI], 1.02–1.31; logistic coefficient 0.15), B/A (as a continuous variable; OR 1.88; 95% CI, 1.19–2.97; logistic coefficient 0.67), and sepsis (OR 3.78; 95% CI, 1.40–10.21; logistic coefficient 1.19). Multiplying the logistic coefficients by 10 and subtracting 75, resulted in the following equation for the score: Score = 12 × (if sepsis) + 1.5 × (TSB) + 7 × (B/A) − 75. The model performed well with an area under the curve of 0.871. The risk of ABE can be quantified according to TSB, B/A, and sepsis in term/near-term neonates with extreme hyperbilirubinemia.

Increased Serum Expression of Inflammatory Cytokines may Serve as Potential Diagnostic Biomarker for Bilirubin Encephalopathy

“…Moreover, the early diagnosis of BE is important for physicians to make effective decisions before appearance of the symptoms and to subsequently reduce the morbidity and mortality of the disease ( 4 ). Several other studies have discussed the potential diagnostic value of some biomarkers for the early diagnosis of BE ( 1 , 6 , 16 , 17 ). In our study, we performed ROC analysis, and the results indicated that either IL-1β or TGF-β could distinguish BE patients from healthy controls with a high specificity and sensitivity.…”

“…The criteria used for exclusion were: neonates who died within 12 h after birth, neonates with incomplete data and information, those with intracranial infection, congenital malformation (chromosome abnormality), and family history of deafness. Severe hyperbilirubinemia: total serum bilirubinemia (TSB) >342 μmol/L; very severe hyperbilirubinemia >427 μmol/L; bilirubin encephalopathy: apart from TSB>342 ( 1 ). There were typical symptoms of nervous system disorders, such as lethargy, convulsion, dystonia, and asthenia.…”

“…In the field of neonate diseases, some infants suffer from bilirubin encephalopathy due to the extremely high serum bilirubin levels and the development of bilirubin-induced neurologic injury ( 1 - 3 ). Bilirubin encephalopathy (BE, also known as kernicterus) can be classified as acute or chronic BE based on the duration of the disease ( 1 ). Although considerable efforts have been made to explore the pathogenesis of the disease and to constantly improve the medical techniques, bilirubin encephalopathy continues to occur frequently.…”

Nomogram for Acute Bilirubin Encephalopathy Risk in Newborns With Extreme Hyperbilirubinemia

“…However, the predictive effect was considered to be unsatisfactory (11,12). A recent study reported a predictive model that included three factors (TSB, bilirubin/albumin ratio, and sepsis) in the risk assessment of ABE (18), but further clinical validation is needed. Furthermore, the scores obtained by this prediction model cannot be directly converted into the prediction probability, which may cause confusion for users.…”

“…The bilirubin/albumin ratio is used as a surrogate for plasma-free bilirubin because it contains two of the three factors (TSB, albumin, and albumin binding affinity) that determine plasma-free bilirubin (25). However, whether bilirubin/albumin ratio can improve the prediction over TSB alone remains controversial (17,18). We think that it is more reasonable to analyze the effect of albumin on ABE in the prediction model already included in TSB.…”