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Clinical factors related to bilirubin encephalopathy in preterm infants: A case-control study
Akihisa Okumura1, Masahiro Hayakawa2, Hiroshi Arai3
1Department of Pediatrics, Aichi Medical University, Japan.
Insights
Bronchopulmonary dysplasia, bacteremia, and high peak total bilirubin levels are key risk factors for bilirubin encephalopathy in preterm infants. These findings can help improve neonatal jaundice treatment.
Area of Science:
- Neonatalogy
- Pediatric Neurology
- Clinical Chemistry
Background:
- Bilirubin encephalopathy in preterm infants (pBE) is a growing concern in neonatal intensive care units.
- Identifying risk factors for pBE is crucial for effective prevention and treatment.
Purpose of the Study:
- To identify the risk factors associated with bilirubin encephalopathy in preterm infants.
Main Methods:
- A 1:2 matched-pair analysis was conducted comparing infants with pBE to control infants.
- Data included demographics, neonatal complications, laboratory values (within 8 weeks), and phototherapy duration.
Main Results:
- Infants with pBE had higher rates of bronchopulmonary dysplasia, gastrointestinal complications, and bacteremia.
- Higher peak total bilirubin, bilirubin/albumin ratios, and lower albumin levels were observed in the pBE group.
- Bronchopulmonary dysplasia, bacteremia, and peak total bilirubin were independent risk factors for pBE.
Conclusions:
- Bronchopulmonary dysplasia, bacteremia, and peak total bilirubin levels are associated with pBE.
- These findings can inform improved treatment strategies for neonatal jaundice in preterm infants.
Objectives:
Bilirubin encephalopathy in preterm infants (pBE) is becoming a growing concern in Japanese neonatal intensive care units. Definitive conclusions regarding the risk factors of pBE remain elusive. This study aimed to identify the risk factors for pBE.
Methods:
We performed a 1:2 matched-pair analysis, selecting infants with pBE from previous nationwide surveys and matching them with control infants without evident neurodevelopmental delay based on year of birth, gestational age, or birth weight. We compared demographic data, neonatal complications, laboratory data within the first 8 weeks of life, and phototherapy between the two groups.
Results:
We analyzed 20 infants with pBE and 40 control infants. Infants with pBE showed higher frequencies of bronchopulmonary dysplasia, gastrointestinal complications (excluding necrotizing enterocolitis), and bacteremia than the controls. Infants with pBE had higher peak total bilirubin levels and bilirubin/albumin ratios, alongside lower bottom albumin levels than controls. The difference in these laboratory values was prominent during the third to fourth weeks of life. Infants with pBE ended phototherapy significantly later than the controls. Multiple regression analysis showed that bronchopulmonary dysplasia, bacteremia, and peak total bilirubin levels were independently associated with pBE.
Conclusions:
Bronchopulmonary dysplasia, bacteremia, and peak total bilirubin values were presumed to be associated with the occurrence of pBE. The results of this study will improve treatment approaches for neonatal jaundice in preterm infants.
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