210例新生儿高胆红素血症高危因素分析

Analysis of high risk factors in 210 neonates with hyperbilirubinemia

目的新生儿高胆红素血症病因及相关危险因素,为临床早防早治新生儿高胆红素血症及预后判断提供参考依据。方法回顾性分析210例新生儿高胆红素血症的病因及相关危险因素。结果210例新生儿高胆红素血症中病因分析明确的占66.7%(140/210),主要原因有新生儿溶血病、感染、新生儿缺氧缺血性脑病、新生儿窒息、G-6-PG缺陷症、早发母乳性黄疸、头颅血肿、肝胆疾病及遗传代谢性疾病;与围产因素相关的占33.3%(70/210),胎膜早破、宫内窘迫、羊水粪染、高龄初产、剖宫产、出生后体重明显下降、母乳缺乏、肝内胆管淤积症、妊娠期高血压、胎龄以及母亲产前使用催产素、镇静剂是新生儿高胆红素血症的主要危险因素。结论积极处理孕期疾病,严格掌握剖宫产指征,减少人为催产的比例,加强高危妊娠、高危分娩的监测,积极喂养并及时处理新生儿期的并发疾病,可以有效地减少高胆红素血症的发生,改善其预后。

Objective To analyze the high risk factors of neonatal hyperbilirubinemia and to provid.e the referential evidences for prevention, treatment and prognostic judgment of neonatal hyperbilirubinemia. Methods Causes and related high risk factors in 210 cases of neonatal hyperbilirubinemia were analyzed. Results One hundred forty patients of 210 cases with neonatal hyperbilirubinemia （66.7%） had obvious causes. The risk factors were hemolytic disease of newborn （HDN）., infections, hypoxic-ischemic encephalopathy （ HIE）, asphyxia of newborn, glucose-6-phosphate dehydrogenase deficiency （ G-6-PD）, pristine breast milk jaundice （BMJ）, haematoma of scalp, diseases of liver and gall, diseases of heritage and metabolism： 70 cases （33.3 G ） were related to perinatal factors. The major risk factor inducing the hyperbilirubinemia were premature rupture of membranes, intrauterine emharrassment,amniotic fluid contaminated by meconium, old primiparity, cesarean section, postnatal excessive loss of weigh, lack of breast milk, cholestasis in intrahepatic bile duct, gestation period hypertension, gestational age and using oxytocin or calmative prior to delivery. Conclusion To deal with the diseases during gestation period actively, control indication of cesarean section strictly, decrease anthropogenic acceleration for delivery, strengthen monitor for high risk gestation and delivery, feed actively and therapy neonatal diseases in time are helpful to reduce incidence of hyperbilirubinemia as well as improve the prognosis.