新生儿及儿科医学

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Analysis of Factors Related to Head MRI Changes in Neonatal Hyperbilirubinemia and Effect on Neurodevelopmental Outcomes

Russel Takam, Ma Shuang, Cong Tianc and Ji Hong

Background and objective: This study aims to detect how hyperbilirubinemia affects cerebral structures by imagery (MRI and DWI) to prevent irreversible future brain damage. It will equally help us examine the relationship between imaging and neurodevelopment.

Research design and methods: In a retrospective, controlled study, 50 infants of 35 weeks gestation or more with hyperbilirubinemia were assigned to two groups based on abnormal or normal head imaging (MRI, DWI). The primary outcomes included peak bilirubin levels according to socio-demographic factors and how these levels influence MRI and DWI imaging. The secondary outcome was neurodevelopment at 1, 3, 6, 9 and 12 months for the imaging changes versus the normal imaging groups assessed by a combined formulaire based on the CDC’s developmental milestones and the Denver II Developmental Screening Test (DDST) by investigators.

Results: Peak total serum bilirubin levels (TSB) in the group with MRI changes was significantly higher than those in the group without MRI changes (342.5 ± 47.6 μmol/L vs. 284.3 ± 46.3 μmol/L), p=0.000. In addition, peak TSB values in the group with abnormal DWI was higher than those with normal DWI (314.9 ± 19.5 μmol/L vs. 302.2 ± 55.3 μmol/L), although the difference between both groups (abnormal imaging vs. normal imaging) was not significant. Odds ratios when observing TSB values with 342 μmol/L as cut-off, showed that participants with TSB ≥ 342 μmol/L were 12.4 times more likely of presenting with abnormal MR imaging (OR=12.4, 95% CI 2.191-70.672). In addition, a cross-tab comparison between MRI and milestones depicts MRI as having a 66.7% and 33.3% sensitivity and specificity rates for milestone attainment. The rate of milestone abnormality in participants with imaging changes was 6.0% (3 out of 50), with 2 out of the 3 participants having abnormal imaging and abnormal milestone attainment, while 1 had normal imaging but abnormal milestone attainment.

Conclusion: A significant relationship between high bilirubin levels and head imaging (MRI) was observed, but these changes in imaging could not significantly predict neurodevelopmental outcomes.