重度黄疸换血新生儿的脑干听觉诱发电位影响因素分析

Study on the influence factors of brainstem auditory evoked potential in newborns underwent exchange transfusion due to severe hyperbilirubinemia

目的分析需动静脉换血治疗的重度黄疸新生儿的脑干听觉诱发电位(BAEP)情况,了解进行换血治疗的重度黄疸新生儿脑干听觉诱发电位异常率、导致BAEP异常的可能相关因素,以便在围生期加强关注、及早进行干预、降低听力损害发生率等不良后果。方法回顾性分析2019年1月—2021年12月本院新生儿病区住院的新生儿病历资料,检索出成功开展换血治疗的重症黄疸新生儿且进行脑干听觉诱发电位检查的患儿,记录患儿脑干听觉诱发电位结果、一般资料、胎龄、体重、换血时日龄、换血前及换血后血清总胆红素水平、直接胆红素水平、住院天数等情况,并根据BAEP结果分为脑干听觉诱发电位异常组和脑干听觉诱发电位正常组两组进行对比。结果共找到91例符合条件的重度黄疸换血并进行脑干听觉诱发电位检查的新生儿,其中5例进行第2次换血,共进行96例次换血治疗,91例BAEP检查中脑干听觉诱发电位异常患儿27例(29.7%)、正常患儿64例(70.3%)。在BAEP异常组新生儿换血前血清总胆红素(TSB)水平[(462.76±128.34)μmol/L]、换血前直接胆红素(DB)水平[(28.24±16.46)μmol/L]、换血时日龄[(6.26±3.50)天]均分别高于BAEP正常组新生儿换血前血清总胆红素水平[(408.12±101.85)μmol/L]、换血前直接胆红素水平[(21.20±6.94)μmol/L]、换血时日龄[(4.16±3.04)天],组间差异均有统计学意义(P<0.05)。脑干听觉诱发电位异常组的新生儿换血后血清总胆红素水平[(229.56±60.86)μmol/L]、换血后直接胆红素水平[(23.07±10.01)μmol/L]、患儿胎龄[(38.92±1.59)周]、体重[(3.042±0.559)千克]与BAEP正常组新生儿换血后血清总胆红素(TSB)水平[(223.97±54.38)μmol/L]、换血后直接胆红素(DB)水平[(21.84±18.97)μmol/L]、患儿胎龄[(39.23±1.21)周]、体重[(3.243±0.413)千克]相比,组间差异均均无统计学意义(P>0.05)。BAEP异常组的新生儿住院天数[(10.89±4.62)天]高于BAEP正常组的新生儿住院天数[(9.16±2.76)天],但组间差异均无统计学意义(P>0.05)。结论重度黄疸换血新生儿的异常脑干听觉诱发电位发生率较高,换血前高血清总胆红素及高直接胆红素、重度黄疸持续时间长患儿脑干听觉诱发电位更易出现异常。因此,及早识别达换血标准新生儿并进行换血有利于降低异常脑干听觉诱发电位发生率。

Objective We analyzed the situation of brainstem auditory evoked potential(BAEP)of children with hyperbilirubinemia those received peripheral arteriovenous exchange transfusion,then find out the abnormal rate of BAEP and possible related factors which leading to the abnormal result of children with severe neonatal hyperbilirubinemia.Finally we can strengthen the attention in the perinatal period and give early intervention then reduce the possible hearing impairment.Methods The case data of newborns those were admit to the neonatal ward of our hospital from January 2019 to December 2021 were retrospectively analyzed.The children,suffered from severe hyperbilirubinemia those underwent peripheral arteriovenous exchange transfusion successfully and brainstem auditory evoked potential detection,were screened out.The data such as brainstem auditory evoked potential result,general information,gestational age,weight,the age when receiving exchange transfusion,the level of serum total bilirubin and direct bilirubin before and after receiving exchange transfusion,hospitalization days were recorded.All newborns were divided into the normal brainstem auditory evoked potential group and the abnormal brainstem auditory evoked potential group according to the BAEP result and the two groups were compared.Results A total of 91 cases meet the standard and 5 of whom receive a second exchange transfusion,thus the newborn underwent 96 times of exchange transfusion.All the newborn receive brainstem auditory evoked potential,27 cases(29.7%)of which are abnormal and 64 cases(70.3%)are normal.In abnormal BAEP group serum total bilirubin level and direct bilirubin level before exchange transfusion,age of exchange transfusion when receiving exchange transfusion,the length of hospital stay were higher/longer than those in the normal group[(462.76±128.34)μmol/L,(28.24±16.46)μmol/L,and(6.26±3.50)days vs(408.12±101.85)μmol/L,(21.20±6.94)μmol/L,(4.16±3.04)days],with statistically significant respectively(P<0.05).There were no statistical difference in serum total bilirubin level and direct bilirubin level after exchange transfusion,gestational age,body weight between the BAEP abnormal group and the normal group respectively[(229.56±60.86)μmol/L,(23.07±10.01)μmol/L,(38.92±1.59)weeks,(3.042±0.559)Kg vs(223.97±54.38)μmol/L,(21.84±18.97)μmol/L,(39.23±1.21)weeks,(3.243±0.413)Kg](P>0.05).The length of hospitalization of neonates in the abnormal group was longer than that in the normal group[(10.89±4.62)days vs(9.16±2.76)days],however,the difference have no statistical significance(P>0.05).Conclusions The newborns with neonatal hyperbilirubinemia who underwent exchange transfusion have a higher incidence of abnormal brainstem auditory evoked potential.Newborns with higher serum total bilirubin level,higher direct bilirubin level and long duration of severe hyperbilirubinemia before blood exchange are more likely to have abnormal brainstem auditory evoked potential.Therefore,early identification of newborns meeting the standard of exchange transfusion and giving them exchange transfusion is beneficial to reduce the incidence of abnormal brainstem auditory evoked potential.