新生儿重症高胆红素血症临床危险因素分析

Analysis of Clinical Risk Factors of Neonatal Severe Hyperbilirubinemia

[目的]探讨引起新生儿重症高胆红素血症的临床危险因素.[方法]2007年7月至2010年7月期间在本院新生儿病房住院的重症高胆红素血症患儿,研究组入选标准：出生7 d之内,血清胆红素峰值达〉342 μmol/L以上,以非结合胆红素增高为主,非结合胆红素占总胆红素的80%以上的患儿.对照组入选标准：足月和早产儿生后7 d之内,血清胆红素峰值分别〉220.16 μmol/L和256.15 μmol/L,但〈342 μmol/L.排除标准：患儿乙肝表面抗原阳性或其他由于肝脏疾病引起的黄疸.研究组79例,对照组96例.应用Logistic回归模型,对临床常见的病因如感染、窒息、头颅血肿、早产、ABO或Rh溶血,遗传代谢病及围生期因素进行回顾性分析.[结果]感染是引起新生儿高胆红素血症的最常见原因,其次是围生期因素,早产,溶血,窒息,头颅血肿,遗传代谢病.应用Logistic回归分析显示,研究组与对照组对比,只有早产及围生期因素在两组间差异存在统计学意义.[结论]新生儿高胆红素血症的病因发生了明显的变迁,临床围生期因素的新生儿重症高胆红素血症将是未来探讨的重点.

[Objective] To explore the clinical risk factors of neonatal severe hyperbilirubinemia. [Methods] Pediatric cases（aged below 7 days after birth） of severe hyperbilirubinemia with the peak of serum bilirubin more than 342gmol/L and unconjugated hyperbilirubinemia（unconjugated bilirubin/total bilirubin ≥ 80% ） in neonatal department of our hospital from August 2007 to April 2010 were selected as the study group. Full term and premature infants（aged below 7 days after birth） with the peak of serum bilirubin more than 220.16 umol/L or 256.15umol/L and less than 342 umol/L were selected as the control group. Pediatric patients who were positive hepatitis B surface antigen or had jaundice caused by other liver diseases were excluded. Logistic regression model was used to analyze the clinical common causes such as infection, asphyxia, cephalohematoma, premature birth, ABO or Rh incompatibility, hereditary metabolic disease and perinatal factors retrospectively. [Results]There were 79 cases in study group and 96 cases in control group. The most common cause of neonatal hyperbilirubinemia was infection, followed by prenatal factors, premature birth, ABO or Rh incompatibility, asphyxia, cephalohematoma and hereditary metabolic disease. Logistic regression analysis showed that there were significant differences in premature birth and perinatal factors between study group and control group. [Conclusion]There is an obvious change in clinical risk factors of neonatal hyperbilirubinemia. Severe neonatal hyperbilirubinemia caused by clinical perinatal factors will be the focus in future study.