产科母婴同室足月新生儿黄疸的管理探讨

Management of jaundice in term infants

目的探讨母婴同室足月儿黄疸的管理,以减少其不必要的住院和实验室检查。方法研究对象为1317例足月儿,每日测血清总胆红素(TSB),筛查高胆红素血症(简称高胆)病因。当健康儿48hTSB≥205μmol/L给口服茵栀黄口服液;如TSB上升≥270μmol/L给予光疗、加配方奶;当TSB峰值≤270μmol/L、吃奶正常、无异常情况则出院,随访208例健康高胆儿。结果827例高胆儿,有病因者76例,12例(15.8%)TSB在220～270μmol/L,64例(84.2%)TSB≥270μmol/L;无病因者751例,558例(74.3%)TSB在220～270μmol/L,193例(25.7%)TSB≥270μmol/L,仅6例TSB≥340μmol/L。被随访者黄疸平均3周消退,4例因出生2周黄疸未退再次入院。结论母婴同室新生儿高胆明显增加,应加强黄疸的监测,及时发现和处理,以防严重黄疸的发生。建议TSB在220～270μmol/L为高胆的临界值;当TSB≥270μmol/L时查病因,给予光疗;同时放宽健康高胆儿出院时TSB指标;出院后应随访,以减少再次入院率。

Objective To investigate the management of neonatal jaundice in term infants so as to prevent from unnecessary tests, treatments and hospitalization. Methods A total of 1 317 term neonates were daily tested of total serum bilirubin （TSB） and possible etiology of neonatal hyperbilirubinemia were screened. Chinese medicine was orally given when TSB at 48h after birth was higher than 205 μmol/L. When TSB ≥ 270 μmol/L, phototherapy and formula were required. When TSB was less than 270 μmol/L and without abnormal manifestation, neonates could be discharged. Two hundred and eight healthy infants with hyperbilirubinemia were followed up. Results In the 827 neonates with TSB≥220μmol/L, 76 had etiological factors and no significant etiological factors was found in 751. Among the 76 cases with causes, 15.8% had TSB at 220～270μmol/L and 84. 2%≥270μmol/L. Among the 751 neonates without causes, 74. 3% had TSB at 220～270 μmol/L and 25.7% ≥270μmol/L. In the followed - up neonates, jaundice disappeared at the mean time of three weeks, four of them were re- hospitalized because of persistent jaundice in 2 weeks. Conclusions Breast - fed infants had significant higher incidence of hyperbilirubi- nemia and close monitor and systemic evaluation of neonatal jaundice are required. TSB at 220～270μmol/L should be regarded as alert value for hyperbilirubinemia. If TSB≥270 μmol/L, possible etiological factors should be check and phototherapy should he given. Healthy newborns with hyperbilirubinemia can be discharged when TSB≥270 μmol/L and followed up until jaundice disappears.