胆红素脑病患儿内在因素及外在高危因素分析

摘要

目的 探讨新生儿胆红素脑病患儿自身伴发疾病及外在高危因素.方法 选择2005年1月至2013年12月本院新生儿科收治的胆红素脑病患儿,记录患儿一般情况、围产期高危因素、伴随疾病及外在高危因素.结果 9年间共收治胆红素脑病患儿52例,胎龄(38.3±2.3)周,出生体重(3 013±483)g,入院日龄(6.7±4.3)天,血清总胆红素(543.6±122.7)μmol/L,血清总胆红素/血浆白蛋白(B/A)比值为(0.96±0.15).52例胆红素脑病患儿中有明确伴发疾病者44例(占84.6％),其中最常见的伴发疾病是新生儿感染,共30例(57.7％),其次为葡萄糖-6-磷酸脱氢酶缺乏症22例(42.3％),有多重伴发疾病19例(36.5％).有50例患儿存在外在诱因(96.2％),其中26例患儿家属未按要求进行出院3天后随访;12例患儿产科出院时存在高胆红素血症,但家人拒绝住院治疗;10例患儿出院时黄疸程度不重,在家喂服中药或外洗后导致黄疸加重.结论 外在高危因素是新生儿发生胆红素脑病的主要原因,根据调查分析结果针对不同高危因素,对新生儿父母进行黄疸危害的宣传,黄疸治疗方法教育、建立规范的随访时间和及时发现感染是减少新生儿胆红素脑病的主要预防措施.%Objective To study the risk factors of neonatal bilirubin encephalopathy.Methods Neonates with bilirubin encephalopathy admitted to the neonatal department of our hospital from January 2005 to December 2013 were recruited and their clinical data retrospectively reviewed,including gender,gestational age,birth weight,total bilirubin level,bilirubin/albumin (B/A),perinatal risk factors,complications and external risk factors.Results A total of 52 cases were recruited.The average gestational age was (38.3 ± 2.3) weeks,the mean birth weight was (3 013 ± 483) grams,the age at admission was (6.7 ± 4.3)days,the highest total bilirubin level was (543.6 ± 122.7)umol/L,and the mean B/A was (0.96 ±0.15).44 cases (84.6％) were complicated with other conditions,including 30 cases (57.7％) with neonatal infection,22 (42.3％) with glucose-6-phosphate dehydrogenase deficiency (G6PD) and 19 (36.5％) with more than one complications.A total of 50 infants (96.2％) had external risk factors.26 of the patients didn't return within 3 days after discharge as required and 12 with hyperbilirubinemia refused to be hospitalized when they left the obstetric department with their mothers.Jaundice deteriorated in 10 patients after Traditional Chinese Medicine treatment.Conclusions External risk factors are the leading causes of neonatal bilirubin encephalopathy.According to the study,the main preventive measures of neonatal bilirubin encephalopathy include parent education of the harms and treatment options of jaundice,establishing a standard system for follow-up,and controlling neonatal infection.