新生儿高间接胆红素血症患儿远期随访观察

Long┐termfolow┐upofneonatalindirecthyperbilirubinemia

为探讨新生儿期血清胆红素水平对远期预后的影响，对９０例新生儿高间接胆红素血症（简称高胆）患儿在５～８岁时进行了智商（ＩＱ）、听力及神经系统检查。结果显示，２３例（２５．６％）有程度不等的ＩＱ低下；１８例（２０．０％）有轻度听力障碍，以低频区为主；３例（３．３％）有神经系统异常。ＩＱ、听力及神经系统异常率与清血总胆红素峰值无显著相关性。约半数异常者血清总胆红素峰值＜２００ｍｇ／Ｌ。溶血组与非溶血组异常率差异无显著意义。提示，除重度高胆外，轻、中度高胆（无论是否溶血症）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。单凭血清总胆红素水平并不能确切预测远期预后。对所有高胆新生儿均应积极治疗，以尽量减少后遗症的发生。

Tounderstandlong-termefectofneonatalhyperbilirubinemia,weevaluatedinteli-gencequotient(IQ),hearingandnervoussystemin90childrenat5～8yearsofagewhohadneona-talindirecthyperbilirubinemia.Theresultsshowedthat23cases(25.6%)hadlowerIQtodiferentextent,18cases(20.0%)hadslighthearingloss,withdominanceinlowerfrequency,and3cases(3.3%)hadneurologicalabnormalitiesandmainlymanifestatedascerebralpalsy.Therewasnosig-nificantcorrelationbetweentheabnormallong-termoutcomeandthepeakbilirubinlevel.Inabout1/2caseswhoexperiencedunfavourableoutcomethepeakserumtotalbilirubinlevelwasunder200mg/L.Therewasnosignificantdiferenceinfrequencyofabnormalitybetweenthehemolyticandthenon-hemolyticgroups,whichsuggeststhatnotonlysevere,butslightandmoderatehyperbiliru-binemiaresultingfrombothhemolyticandnon-hemolyticdiseasesmayhavepermanentneurotoxicitytonewborninfant,resultinginabnormalpsycho-neurologicaldevelopment.Serumtotalbilirubinlev-elcannotpreciselypredictlong-termoutcome.Alneonatalindirecthyperbilirubinemiashouldbetreatedaggresivelysothatpsycho-neurologicalsequelaecanbeminimized.