Relationship Between Unbound Bilirubin Levels and Acute Bilirubin Encephalopathy in Exchange Transfusion Neonates

doi:10.21203/rs.3.rs-154330/v1

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Relationship Between Unbound Bilirubin Levels and Acute Bilirubin Encephalopathy in Exchange Transfusion Neonates

https://doi.org/10.21203/rs.3.rs-154330/v1

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BACKGROUND: Evidence regarding the relationship between unbound bilirubin levels and acute bilirubin encephalopathy was limited. Therefore, this study set out to investigate whether the unbound bilirubin level was independently related to acute bilirubin encephalopathy in children who underwent exchange transfusion after adjusting for other covariates.

METHODS: A total of 46 neonates who underwent exchange transfusion were involved in The First People's Hospital Of Changde City in China from 2016-1-1 to 2018-12-31. The target independent variable and the dependent variable were unbound bilirubin levels measured at baseline and acute bilirubin encephalopathy respectively. Covariates involved in this study included sex, age, birth weight, blood glucose, red blood cell, hemolysis, receive phototherapy before exchange transfusion.

RESULTS: The average gestational age of 46 selected participants was 38.6 ± 1.3 weeks old, the average age was 146.5 ± 86.9 hours old, 52.17% of them were male. Result of fully-adjusted binary logistic regression showed unbound bilirubin levels were positively associated with risk of acute bilirubin encephalopathy after adjusting confounders (Odds ratio = 1.41, 95% confidence intervals 1.05-1.91, P value <0.05).

CONCLUSION: Unbound bilirubin levels are associated with neonatal acute bilirubin encephalopathy. The mechanism of unbound bilirubin levels leading to neonatal acute bilirubin encephalopathy needs to be further explored.

Pediatrics

neonatal

acute bilirubin encephalopathy

exchange transfusion

unbound bilirubin.

Table 1. Characteristics of participants (n=46)

ABE	no	yes	P-value
n	28	18
Admission data
Age, mean (SD), hours	128.7 (94.2)	174.2 (67.6)	0.042
Gestational age, mean (SD), weeks	38.8 (1.5)	38.3 (0.9)	0.205
Birth weight, mean (SD), kilogram	3.28 (0.35)	3.25 (0.45)	0.825
Weight, mean (SD), kilogram	3.14 (0.39)	3.13 (0.41)	0.923
Female, No. (%)	15 (53.57%)	7 (38.89%)	0.331
Laboratory data
TSB₁, mean (SD), mg/dL	25.96 (5.53)	33.77 (5.94)	<0.001
UB, mean (SD), mg/dL	23.74 (5.12)	30.35 (5.54)	<0.001
TSB₂, mean (SD), mg/dL	11.13 (3.32)	17.53 (6.27)	<0.001
Blood glucose, mean (SD), mmol/L	5.3 (1.2)	6.9 (3.0)	0.017
White blood cell, mean (SD), *10^⋀9/L	13.2 (5.1)	14.2 (4.7)	0.508
Blood platelet count, mean (SD), *10^⋀9/L	289.7 (125.6)	264.0 (116.0)	0.493
Red blood cell, mean (SD), *10^⋀12/L	4.07 (1.08)	3.29 (0.72)	0.010
Hemoglobin, mean (SD), g/L	143.2 (35.5)	116.1 (29.6)	0.011
Serum sodium, mean (SD), mmol/L	142.5 (3.0)	142.1 (2.6)	0.584
Serum calcium, mean (SD), mmol/L	2.40 (0.25)	2.38 (0.17)	0.762
Serum potassium, mean (SD), mmol/L	4.62 (0.52)	4.39 (0.38)	0.117
Serum albumin, mean (SD), g/L	37.45 (2.80)	36.12 (4.16)	0.201
Etiology
Hemorrhage, No. (%)	6 (21.43%)	3 (16.67%)	0.691
Hemolysis, No. (%)	16 (57.14%)	12 (66.67%)	0.518
Infection, No. (%)	11 (39.29%)	8 (44.44%)	0.729
Erythrocytosis, No. (%)	2 (7.14%)	0 (0.00%)	0.246
Unknown reason, No. (%)	1 (3.57%)	3 (16.67%)	0.124
Treatment
Iv immunoglobulins before ET, No. (%)	6 (21.43%)	7 (38.89%)	0.199
Receive phototherapy before ET, No. (%)	25 (89.29%)	11 (61.11%)	0.024

TSB₁：TSB at starting ET

TSB₂：TSB at end of the ET

Hemorrhage: include scalp hematoma, intracranial hemorrhage showed by MRI, and abdominal Haemorrhage showed by ultrasonography.

Hemolysis: include ABO haemolytic, RhD haemolytic, Autoimmune haemolytic and Glucose-6-phosphate Dehydrogenase defificiency.

Infection: include sepsis, pulmonary infection, intracranial infection and umbilical infection.

Table 2. Relationship between UB VS ABE in different models

	OR（95%CI）	P-value
Non-adjusted	1.29 (1.10, 1.52)	0.002
Adjust I	1.34 (1.11, 1.63)	0.003
Adjust II	1.41 (1.05, 1.91)	0.025

Result variable: ABE

Exposure variable: UB

Non-adjusted model adjust for: None

Adjust I model adjust for: Sex; Age; Birth weight;

Adjust II model adjust for: Sex; Age; Birth weight; Blood glucose; Red blood cell; Hemolysis; Receive phototherapy before ET;

No competing interests reported.

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Relationship Between Unbound Bilirubin Levels and Acute Bilirubin Encephalopathy in Exchange Transfusion Neonates

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