新生儿重度高胆红素血症的高危因素及预后分析

Analysis of Risk Factors and Prognosis of Severe Hyperbilirubinemia in Neonates

目的探讨新生儿重度高胆红素血症的常见病因及预后转归,为临床防治提供依据。方法回顾性分析2018年1月至2020年1月郑州大学第三附属医院新生儿科收治的216例新生儿高胆红素血症患儿的病例资料,其中血清总胆红素(T-Bil)≥342μmol·L^(-1)为重度高胆红素血症组(98例),应用随机抽样法选取同时间段血清T-Bil为220.6~342μmol·L^(-1)的118例患儿为轻中度组,分析患儿的临床特征及治疗结局。结果98例新生儿重度高胆红素血症病因依次为新生儿感染(30.61%)、新生儿溶血病(28.57%)、胎便排出延迟(27.55%)、体质量下降(24.49%)、新生儿窒息(22.44%)、颅内出血(15.30%)。多因素logistic回归分析显示,新生儿感染、新生儿溶血病、胎便排出延迟及生后体质量下降是引起新生儿重度高胆红素血症的独立危险因素;急性胆红素脑病组头颅磁共振成像(MRI)、自动听性脑干反应(AABR)异常率均高于非急性胆红素脑病组。结论新生儿感染、新生儿溶血病、胎便排出延迟及生后体质量下降是引起新生儿重度高胆红素血症的危险因素,头颅MRI及AABR对急性胆红素脑病的预测价值高,值得临床推广应用。

Objective To explore the common causes and prognosis of neonatal severe hyperbilirubinemia,so as to provide basis for clinical prevention and treatment.Methods The data of 216 cases of neonatal hyperbilirubinemia treated in the Department of Neonatology of the Third Affiliated Hospital of Zhengzhou University from January 2018 to January 2020 were analyzed retrospectively.Serum total bilirubin(T-Bil)≥342μmol·L^(-1) was the severe hyperbilirubinemia group(98 cases).The 118 children whose serum T-Bil ranged from 220.6 to 342μmol·L^(-1) during the same time were selected as the mild to moderate group by random sampling.The clinical characteristics and treatment outcomes were analyzed.Results The causes of 98 cases of neonatal severe hyperbilirubinemia were neonatal infection(30.61%),neonatal hemolytic disease(28.57%),delayed fetal stool excretion(27.55%),weight loss(24.49%),neonatal asphyxia(22.44%)and intracranial hemorrhage(15.30%).Multivariate logistic regression analysis showed that neonatal infection,neonatal hemolytic disease,delayed fetal stool excretion and postnatal weight loss were independent risk factors for severe neonatal hyperbilirubinemia.The abnormal rates of cranial magnetic resonance imaging(MRI)and automatedauditory brainstem response(AABR)in acute bilirubin encephalopathy group were higher than those in non-acute bilirubin encephalopathy group.Conclusion Neonatal infection,neonatal hemolytic disease,delayed fetal stool excretion,postnatal weight loss are the risk factors of severe neonatal hyperbilirubinemia.Cranial MRI and AABR have high predictive value for acute bilirubin encephalopathy,which is worthy of clinical application.