63例新生儿高胆红素血症的临床预后分析

Prognostic analysis of neonatal indirect hyperbilirubinemia

目的 :探讨高胆红素血症 (简称高胆 )新生儿血清胆红素水平对其远期预后的影响。方法 :对 63例高胆新生儿作 1～8.5年远期随访 ,并作智能、神经系统及体格检查。结果 :19例 ( 3 0 .2 % )有程度不等的智能异常 ;7例 ( 11.1% )有神经系统异常 ;1例 ( 1.6% )有体格发育异常。智能、神经系统及体格发育异常与血清胆红素水平无显著相关性。异常者约半数血清胆红素水平 <3 40 μmol·L- 1 。溶血组与非溶血组异常率差异在智能及神经系统方面有显著意义。除重度高胆外 ,轻、中度高胆 (无论溶血与否 )也可对新生儿产生永久性神经毒性作用 ,导致精神神经发育异常。结论 :单凭血清胆红素水平并不能确切预测高胆远期预后。对新生儿高胆 ,尤其是溶血性高胆更应积极防治 。

Objective To investigate long-term effect of neonatal hyperbilirubinemia. Methods Intelligence, nervous system and physical growth in 63 children at 1-8.5 years of age who had neonatal indirect hyperbilirubinemia were analyzed. Results 19 cases(30.2%) had intelligence retardation to different extent, 7 cases(11.1%) had neurological abnormalities, and 1 case(1.6%) had abnormal physical growth. There was no significant correlation between the long-term abnormal outcome and the serum bilirubin level. In about half of the cases who experienced unfavourable outcome, the serum bilirubin level was under 340?μmol·L -1. There were significant differences of frequency of abnormal intelligence and nervous system between the hemolytic and the non-hemolytic groups, which suggested that not only severe, but also slight and moderate hyperbilirubinemia, resulting from both hemolytic and non-hemolytic disease, exerted permanent neurotoxicity to new born infant resulting in abnormal psycho-neurological development.Conclusions Serum bilirubin level dose not precisely predict long-term outcome. Neonatal indirect hyperbilirubinemia, especially due to hemolytic disease should be prevented and treated more aggressively to minimize psycho-neurological sequellae.