Objective To investigate the risk factors and predictors of poor outcome in full-term neonates with severe hyperbilirubinemia. Methods Data were retrospectively collected from 326 neonates with severe hyperbilirubinemia hospitalized between January 1, 2012 and December 31, 2012. Results A total of 326 full-term neonates with severe hyperbilirubinemia were included in this study (181 males and 145 females). The average gestational age was 39.12±1.17 weeks. Two hundred and sixty (260) cases were followed up successfully by phone while 66 cases were lost to follow-up. Infection (74.40%) and hemolytic disease (51.19%) were the main causes of severe hyperbilirubinemia. Multiple factors regression analysis found that threshold TSB was an independent risk factor of poor outcome (OR=2.02, 95%CI:1.13~3.62, P=0.018). The outcome of neonates with BIND scored between 0-6 had poor prognosis and some of them were reversible, and the outcome in those scored between 7-9 were of worse prognosis. Threshold TSB, USB and B/A ratio in group of poor outcome were signiifcantly higher than those in other groups and their area under the ROC curve evaluating the prognosis was 0.682, 0.671 and 0.698, respectively. With TSB at 474.5 µmol/L, UCB at 449.15 µmol/L and B/A at 0.923 mg/g, Youden index was the higest. The results of BAEP, OSE, MRI and NBNA were not signiifcantly different between groups with or without poor outcome. Conclusions Threshold TSB is an independent risk factor of poor outcome in full-term newborns with severe hyperbilirubinemia. BIND score is a very good predictor of outcome. TSB threshold, USB and B/A ratio are the predictors of outcome, but their diagnostic values are limited. NBNA, hearing screening and hyperintense globus pallidus on T1W1 in the acute phase of jaundice might not related with neurologic prognosis.%目的：探讨足月重度高胆红素血症患儿发生不良预后的危险因素及评估方法。方法回顾性分析2012年1月至2012年12月间在杭州市儿童医院新生儿科住院的足月重度高胆红素血症患儿的临床资料及随访结果。结果入选326例重度高胆红素血症足月儿，平均胎龄(39.12±1.17)周，男181例、女145例；失访66例，成功随访260例。感染性疾病(74.40%)及新生儿溶血病(51.19%)为足月儿重度高胆红素血症的主要病因。多因素Logistic回归分析显示，血清总胆红素(TSB)峰值升高是不良预后的独立危险因素(OR=2.02，95%CI：1.13~3.62，P=0.018)。BIND评分0~6分组不良预后较轻且有一定可逆性，7~9分组均发生严重不良预后。TSB峰值、血清未结合胆红素(UCB)值、TSB与白蛋白比值(B/A)评价不良预后的ROC曲线下面积分别为0.682、0.671、0.698，TSB=474.50μmol/L，UCB=449.15μmol/L，B/A=0.92 mg/g时约登指数最大。脑干听觉诱发电位(BAEP)、耳声发射(OAE)、颅脑磁共振成像(MRI)、新生儿神经行为评分(NBNA)的异常率在有、无不良预后两组间的差异均无统计学意义(P>0.05)。结论 TSB峰值越高，重度高胆红素血症足月儿发生不良预后危险性越大。BIND评分表评估不良预后尤其是严重不良预后有较好价值。TSB峰值、UCB值、B/A值是评估不良预后指标，但诊断价值较低。未发现急性期NBNA、听力筛查结果及苍白球信号改变与远期预后相关。
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