新生儿高间接胆红素血症1444例临床分析

The Linical Analysis of 1444 Neonates with Indirect Hyperbilirubinemia

目的 探讨新生儿高间接胆红素血症 (简称高胆 )的病因及临床特点。 方法 对我院1990年 1月～ 1999年 12月收治的资料完整的 144 4例高胆病例按其病因或相关疾病分为六组进行回顾性分析。 结果 高胆患儿占同期新生儿住院例数的 34 .7% ,男∶女 =1.4∶ 1,发病日龄小于 7d者占 95 .8% ,血清胆红素峰值最高达 5 13μmol/ L ,病因依次为围产因素 (2 8% )、原因不明 (2 4% )、新生儿溶血病 (2 0 % )、母乳性黄疸 (14% )、感染 (10 % )及其他因素。新生儿溶血病出现黄疸时间明显早于其余各组 (P <0 .0 5 ) ,但重度黄疸所占比例与感染组及母乳性黄疸组比差异无显著性 (P >0 .0 5 )。母乳性黄疸组早发型占 85 % ,晚发型占 15 % ,出现黄疸及胆红素达峰值时间均晚于其他组(P<0 .0 5 ) ,但住院日数明显少于其他组 (P<0 .0 5 )。感染因素组住院时间最长 (P<0 .0 0 1)。各组胆红素峰值之间差异无显著性 (P>0 .0 5 )。所有病例均治愈 ,无胆红素脑病发生。 结论 高胆占住院新生儿的比例较 2 0世纪 80年代有所下降 ,围产因素仍为发病的首要因素 ,不明原因高胆及早发型母乳性黄疸病例增多 ,除胆红素值大于目前标准外 ,其他临床特征均与生理性黄疸相似 ,提示这两组可能包括部分生理性黄疸 。

Objective To investigate the causes and clinical characteristics of indirect hyperbilirubinemia in newborns. Methods According to causes ,1 444 cases with indirect hyperbilirubinemia from 1990 to 1999 admitted to our hospital were divided into six groups ,the incidence and clinical characteristics of different groups were analyzed. Results Hyperbilirubinemia accounts for 34.7% among all neonates admitted to hospital. The ratio of male to female is 1.4:1. 95.8% of cases occur jaundice within 7 days of birth.The peak value of serum bilirubin is 513μmol/L .The cause seriation in newborns with indirect hyperbilirubinemia were perinatal factor(28%) ,unknown reason(24%) ,hemolytic disease(20%) ,breast jaundice(14%)and infection(10%). The age( mean +/ SD )of onset of hyperbilirubinemia induced by hemolytic disease of newborns was significantly earlier than that due to other causes( P <0.05), while the proportion of severe jaundice have no significance among the groups of hemolytic disease, breast jaundice and infection( P >0.05).The time that jaundice was discovered and bilirubin come to peak value in breast jaundice was later than other groups ( P <0.05). There was no significant difference in peak valure of bilirubin among six groups( P > 0.05). Conclusions The incidence of neonatal indirect hyperbilirubinemia was decreased compared with era of 80s. Perinatal factor was still the first important cause of hyperbilirubinemia. Part of unknown cause cases and breast feeding jaundice might be physiological jaundice.Control and reduce the pathological perinatal factors could brought to the reduction of incidence of neonatal indirect hyperbilirubinemia.