足月儿高胆红素血症482例相关因素分析

Clinical analysis of neonatal hyperbilirubinemia in 482 full-term newborns

目的探讨足月儿高胆红素血症(简称高胆)的相关因素以及高胆程度。方法对2001年7月—2006年7月收治的高胆足月儿482例进行分析。结果482例高胆患儿中,早发型母乳性黄疸178例(36.9%,其中70.3%为剖宫产),迟发型母乳性黄疸125例(25.9%),ABO血型不合溶血60例(12.5%),围产相关因素54例(11.2%),感染相关因素49例(10.2%),其他16例(3.3%)。以溶血者总血清胆红素最高(351.0±188.1)μmol/L。482例高胆患儿中轻、中、重度分别占42.5%、36.3%和21.2%。重度高胆中早发型母乳性黄疸31例(30.4%),ABO溶血20例(19.6%),迟发型母乳性黄疸25例(24.5%)。482例中核黄疸4例,1例为严重酸中毒、脱水,3例为ABO溶血。结论母乳性黄疸为住院足月儿高胆的主要原因,剖宫产可能与早发型母乳性黄疸有关;ABO溶血是导致患儿核黄疸的主要原因。

Objectives To investigate the etiologies of neonatal hyperbilirubinemia. Methods Clinical data of 482 full-term neonates with neonatal hyperbilirubinemia, admitted in Bethune International Peace Hospital from July 2001 to July 2006, were analyzed. Results Causes of hyperbilirnbinemia were early-onset breastfeeding jaundice （36.9%, 70.3% of them were born by caesarean section） , late-onset breastfeeding jaundice （25.9%）, ABO incom- patibility hemolytic diseases （ 12.5%）, perinatal risk factors （11.2%）, infections （10.2%） and others （3.3%）. Total bilirnbin level was the highest in newborns with hemolytic disease. The percentages of mild, moderate and severe jaun-dice were 42.5%, 36.3%, and 21.2%, respectively. Among patients with severe jaundice, 20 （30.4%） were with early-onset breastfeeding jaundice, 20 （19.6%） were with hemolytic disease, and 25 （24.5%） were with late-onset breastfeeding jaundice. There were 4 patients with kernicterns included in this study （3 patients with hemolytic disease, one with severe acidosis and dehydration）. Conclusions The most common cause of full-term neonatal hyperbilirnbinemia in inpatients is breastfeeding jaundice. Hemolytic diseases account for the majority of kernicterns.