Objective Severe neonatal hyperbilirubinemia can cause neurological disability or mortality if not effectively managed. Exchange transfusion (ET) is an efficient treatment to prevent bilirubin neurotoxicity. The purpose of this study was to evaluate outcomes in severe neonatal hyperbilirubinemia with ET and to identify the potential risk factors for poor outcomes.

Methods Newborns of ≥28 weeks of gestational age with severe hyperbilirubinemia who underwent ET from January 2015 to August 2019 were included. Demographic data were recorded and analyzed according to follow-up outcomes at 12 months of corrected age. Poor outcomes were defined as death due to bilirubin encephalopathy or survival with at least one of the following complications: cerebral palsy, psychomotor retardation (psychomotor developmental index < 70), mental retardation (mental developmental index < 70), or hearing impairment.

Results A total of 524 infants were eligible for recruitment to the study, and 62 infants were lost to follow-up. The outcome data from 462 infants were used for grouping analysis, of which 398 cases (86.1%) had normal outcomes and 64 cases (13.9%) suffered poor outcomes. Bivariate logistic regression analysis showed that peak total serum bilirubin (TSB) (odds ratio [OR] = 1.011, 95% confidence interval [CI] = 1.008–1.015, p = 0.000) and sepsis (OR = 4.352, 95% CI = 2.013–9.409, p < 0.001) were associated with poor outcomes of hyperbilirubinemia. Receiver operator characteristic curve analysis showed that peak TSB ≥452.9 µmol/L could predict poor outcomes of severe hyperbilirubinemia.

Conclusion Peak TSB and sepsis were associated with poor outcomes in infants with severe hyperbilirubinemia, and peak TSB ≥452.9 µmol/L could predict poor outcomes.

目的 新生儿严重高胆红素血症若得不到有效管理，可导致神经功能障碍或死亡。换血（ET）是预防胆红素神经毒性的有效治疗方法。本研究的目的是评估 ET 对严重新生儿高胆红素血症的结局，并确定不良结局的潜在危险因素。

方法 纳入2015年1月至2019年8月接受ET的≥28周胎龄严重高胆红素血症新生儿。根据矫正年龄 12 个月时的随访结果记录和分析人口统计数据。不良结局被定义为因胆红素脑病导致的死亡或至少存在以下并发症之一的存活：脑瘫、精神运动发育迟缓（精神运动发育指数 < 70）、智力发育迟缓（智力发育指数 < 70）或听力障碍。

结果 共有524名婴儿符合纳入研究的条件，62名婴儿失访。采用462例婴儿结局资料进行分组分析，其中398例（86.1%）结局正常，64例（13.9%）结局不佳。双变量逻辑回归分析显示血清总胆红素 (TSB) 峰值（优势比 [OR] = 1.011, 95% 置信区间 [CI] = 1.008–1.015, p  = 0.000）和败血症（OR = 4.352, 95% CI = 2.013 –9.409, p  < 0.001）与高胆红素血症的不良结果相关。接受者操作特征曲线分析表明，峰值 TSB ≥452.9 µmol/L 可以预测严重高胆红素血症的不良结果。

结论 TSB峰值和脓毒症与严重高胆红素血症婴儿的不良预后相关，峰值TSB≥452.9 µmol/L可预测不良预后。