高胆红素血症对婴儿神经行为发育的影响及其早期干预研究

The influence of hyperbilirubinemia on infant's neurobehavioral development and effects of early intervention

目的探讨高胆红素血症(hyperbilirubinemia,HB)对婴儿神经行为发育的影响及其早期干预的效果。方法根据血清未结合胆红素(unconjugat-ed bilirubin,UCB)水平,将系统管理中出生后3d的126例足月新生儿分为:对照组[(125.12±20.36)μmol/L]30例、HBⅠ组[(215.71±35.12)μmol/L]33例、HBⅡ组[(274.16±42.55)μmol/L]31例和HBⅢ组[(382.02±56.03)μmol/L]32例。在此基础上,给予HB组干预性治疗;出生后第3、7、14和28天,进行血清UCB测定和新生儿20项神经行为评定;出生后第1、3、6和12个月,运用Gesell发育诊断量表进行神经行为发育商数评估。结果HBⅢ组神经行为评分和神经行为发育商数最低,HBⅡ组和HBⅠ组次之,对照组最高。干预后,HB组血清UCB水平均降低,神经行为评分和神经行为发育商数均提高;出生后第12个月时,HBⅠ组和HBⅡ组神经行为发育商数与对照组相近(P>0.05),HBⅢ组与对照组比较差异仍存在极显著统计学意义(t=13.472,P<0.01)。结论新生儿HB可影响婴儿神经行为发育,早期干预能改善其影响。

Objective To explore the influence of hyperbilirubinemia （ HB ） exposure on infant＇ s neurobehavioral development and evaluate the effects of early inteivention. Methods One hundred and twenty six infants were divided into four groups ：30 infants in control group [ （ 125. 12 ±20. 36 ） μmol/L ], 33 infants in HB Ⅰgroup[ （215.71± 35.12）μmol/L] ,31 infants in HB Ⅱ group [ （274. 16 ±42. 55 ）μmol/L] and 32 infants in HBm group [ （382. 02 ± 56. 03）μmol/L] on the 3rd day after their birth by serum unconjugated bilirubin （ UCB ） level. On the basis infants of HB groups were provided with interventional measures, and for all infants the tests were repeated for serum UCB concentration and neonatal behavioral neurological assessment （NBNA） on the 3rd, 7th, 14th and 28th days after their birth, and the Gesell developmental diagnosis scales（GDDS） on the 1 st, 3rd ,6th and 12th month after their birth. Results The infant＇s NBNA and GDDS were associated with the level of serum UCB, and the developmental quotient was the highest in control group, the lowest in HBⅢ group, the lesser HB Ⅱand HB Ⅰgroups. Changes in serum UCB concentration and developmental quotient were detected in three HB groups with statistical significance at P 〈0. 01 after interventional measures. However the changes of developmental quotient were more remarkable in the HB Ⅰgroup and HB Ⅱgroup,and in 12th month there was not statistically significant than control group（P 〉0. 05）, while the significant difference was found between in the HB m group and control group（ t = 13. 472, P 〈 0.01 ）. Conclusions HB interfered infant＇s neurobehavioral development and early intervention can improve developmental quotient.