新生儿高直接胆红素血症的随访评价

Clinical prognosis of the newborn direct hyperbilirubinemia

目的随访评价新生儿期高直接胆红素血症(高直胆)预后对新生儿生长发育的影响。方法 2012年1月-2014年12月在丹阳市儿童医院新生儿科和丹阳市人民医院小儿科住院收治的新生儿高直胆患儿79例作为病例组,同期在该院儿保门诊查体的同病例组年龄、性别匹配的正常健康新生儿92例作为对照组,通过临床资料收集、儿童保健科医生现场问卷调查和临床预后健康检查,获得新生儿出生质量、婴幼儿一般情况、患儿高直胆患病情况、婴幼儿体格发育和智能发育情况。结果病例组患儿与对照组儿童性别、随访年龄、分娩方式均差异无统计学意义(P>0.05),但新生儿胎龄、出生体质量差异具有统计学意义(P<0.05)。病例组中,血Hbs Ag阳性率6.33%,7例梅毒TPPA阳性,尿或血CMV-PCR检查阳性38.89%。肝胆B超阳性率69.33%。30例在新生儿期有肠道外营养史。治愈和好转率66.67%,治疗前后血清胆红素相关生化指标差别有显著统计学意义。体格发育方面两组头围、体重及身高差别无统计学意义(P>0.05)。智能发育方面:病例组无论感觉还是运动发育均明显落后于对照组,差别有统计学意义(P<0.05)。结论新生儿高直接胆红素血症患儿临床预后较差,虽然未发现引起体格发育障碍,但是可引发明显的智能发育障碍。因此,应加强随访,早期积极干预,提高生存质量。

Objective To study the effect of follow-up evaluation neonatal high straight bravery prognosis of neonatal growth and development. Methods There was no statistically significant difference in newborns＇ gender, age and mode of delivery between the case group and control group （ P 〉 0.05 ）, but in the gestational age, birth weight there were statistically significant differences （ P 〈 0. 05 ）. There were 7 cases with syphilis TPPA positive in the case group, the positive rate of serum HbsAg examination is 6.33%, the positive rate of urine or blood CMV-PCR examination was 38.89%. The positive rate of Hepatobiliary B ultrasound examination is 69. 33%. There are 30 cases of parenteral nutrition in neonatal period of history. The cure and improvement rate of neonatal hyperbilirnbinemia was 66.67%. There were statistically significant differences in related biochemical indexes of serum bilirubin before and after treatment . There was no statistically significant difference in head circumference, weight and height of physical growth between the case group and control group （ P 〉 0.05 ）. Newborns in the case group were worse than those in the control group in sensory and motor development of Intelligent development , there were statistically significant differences between the two groups （ P 〈 0.05 ）. Results During January 2012 to December 2014 , we get 79 direct hyperbilirubinemia neonatus as the case group that are from newborn department of pediatrics at children＇ s hospital and people＇ s hospital pediatric in Dan yang city . At the same time ,92 normal healthy newborns is regarded as the control group , and the controls selected from the same hospital child health clinic matches the cases with gender and age. Through the clinical data, child care practitioner scene questionnaire survey and clinical prognosis of health examination, we acquire some target data, such as the quality of neonates, the common situation of infants, direct hyperbilirnbinemia prevalence, physical growth and intelligence development of infants . Conclusion The direct hyperbilirnbinemia neonatus have poor clinical outcomes. Although physical development obstacles are not found , intelligence developmental disorder is obvious. Therefore, we should strengthen the follow-up, early active intervention, and improve the life quality of newborns.