延迟断脐对新生儿黄疸的影响

Effect of delayed cord clamping on neonatal jaundice

目的胎儿娩出后即刻断脐是临床上的一贯做法,而延迟断脐可以使胎盘内的胎儿血充分回流,让新生儿得到更多的血液,对预防新生儿贫血等有积极作用,但是否也增加了新生儿黄疸的风险,临床尚无可靠证据。本研究通过实施早、晚断脐的对比研究,探讨延迟断脐对经阴道分娩足月新生儿黄疸的影响。方法选取温州医科大学附属第二医院2017年7—9月足月阴道分娩的延迟断脐的900例新生儿作为观察组,同时选择967例早断脐的新生儿作为对照组,观察组在新生儿娩出后30~180 s之间结扎并截断脐带,对照组在新生儿娩出30 s内结扎并截断脐带,观察2组新生儿每日经皮胆红素平均值、新生儿黄疸发生率、高胆红素血症的发生率、胆红素脑病发生率等指标,并将所得结果进行对比分析研究。结果 2组新生儿每日经皮胆红素平均值比较,产后1~5 d观察组新生儿黄疸值依次为(3.43±0.76)mg/dl、(7.15±0.85)mg/dl、(11.23±0.74)mg/dl、(12.37±1.04)mg/dl及(13.68±1.49)mg/dl,对照组新生儿黄疸值依次为(3.12±0.43)mg/dl、(7.07±0.74)mg/dl、(11.11±0.68)mg/dl、(12.01±1.13)mg/dl及(12.96±1.58)mg/dl,同一时间相比,新生儿黄疸值观察组均高于对照组,但差异无统计学意义(P>0.05)。对照组中,新生儿病理性黄疸22例(发生率2.28%),观察组中,新生儿病理性黄疸23例(发生率2.56%),2组新生儿病理性黄疸及胆红素脑病发生率比较差异无统计学意义(均P>0.05)。2组新生儿均未发生胆红素脑病。结论延迟断脐对新生儿黄疸无明显影响,不增加高胆红素血症发生率。

Objective Immediate cord clamping （ICC） is a routine clinical practice after delivery of the fetus, however, delayed cord clamping （DCC） can make the fetal blood in placenta flow back sufficiently to collect more flood, and has positive effects on the prevention of neonatal anemia. No study has confirmed the risk of DCC on neonatal jaundice. The aim of this study is to explore the effects of DCC on neonatal jaundice in full term vaginal delivery neonates through comparing ICC and DCC. Methods A total of 1 867 eases with full term vaginal delivery were selected in the second hospital affiliated to Wenzhou city in Zhejiang province July, 2017 to September, 2017, they were divided into observation group and control group randomly. Nine hundred infants in observation group received delayed cord clamping and 967 infants in control group received routine cord clamping. Umbilical cord of infants in the observation group was clamped from 30 s to 180 s after delivery, then umbilical cord in the control group was clamped in 30 s after delivery. They were monitored and compared in two groups that the level of neonatal daily transcutaneous bilirubin, the incidence of neonatal jaundice, the incidence of high blood bilirubin, bilirubin eneephalopathy incidence index. Results The level of neonatal daily transcutaneons bilirubin in 1 - 5 day were examined, they were （ 3.43 ± 0.76 ）, （ 7. 15 ± 0.85 ）, （ 11.23 ± 0. 74）, （ 12.37 ± 1.04） and （ 13.68 ± 1.49 ） mg/dl in observation group and which were （ 3.12 ± 0.43 ）, （ 7.07 ± 0.74）, （ 11.11 ± 0.68）, （ 12.01 ± 1.13 ） and （ 12.96 ± 1.58） mg/dl. The level of neonatal daily transcutaneous bilirubin in observation group was higher than that in control group, but no significant difference was found between the two groups （ P 〉 0.05 ）. There were the same results in the incidence of neonatal jaundice, the incidence of high blood bilirubin and blue light treatment. And there were no bilirubin eneephalopathy in the two groups. Conclusion Delayed cord clamping has no significant effect on neonatal jaundice, and does not increase incidence of neonatal jaundice, It is safety and feasible, deserve the clinical expansion.