重症新生儿ABO溶血病的高危因素分析

Analysis of high risk factors of severe neonatal ABO hemolytic disease

目的探讨重症新生儿ABO溶血病(ABO HDN)的高危因素。方法选取2016年1月至2020年6月西北妇女儿童医院新生儿科收治的815例ABO HDN患儿作为研究对象,按照血清总胆红素水平将其分为重症组(72例,≥342μmol/L)和非重症组(743例,<342μmol/L)。收集两组的临床资料,包括性别、胎龄、出生体重、入院年龄、体重下降、血型、胎膜早破、羊水污染、头颅血肿、宫内感染、母亲妊娠史、妊娠期合并症等方面,采用单因素分析及多因素Logistic回归分析进行重症ABO HDN高危因素的分析。结果单因素分析结果显示,两组的性别、胎龄、出生体重、体重下降、血型、胎膜早破、羊水污染、妊娠高血压疾病、妊娠期糖尿病以及喂养方式比较,差异无统计学意义(P>0.05);两组的入院年龄、头颅血肿、宫内感染、母亲妊娠史、剖宫产比较,差异具有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,头颅血肿、宫内感染、母亲非首次妊娠以及剖宫产是重症ABO HDN的危险因素(P<0.05),其比值比(OR)分别为2.873、2.025、4.340与2.803。结论头颅血肿、宫内感染、母亲非首次妊娠以及剖宫产是重症ABO HDN的高危因素。对于高危孕妇及有高危风险因素的新生儿,临床应加强识别与管理,早期诊断、治疗,防止重症ABO溶血及胆红素脑病的发生。

Objective To investigate the high risk factors of severe neonatal ABO hemolytic disease(ABO HDN).Methods A total of 815 children with ABO HDN admitted in the neonatology department of Northwest Women's and Children's Hospital from January 2016 to June 2020 were selected as the research objects,and the children were divided into severe group(72 cases,≥342μmol/L)and non-severe group(743 cases,<342μmol/L)according to serum total bilirubin level.The clinical data of the two groups were collected,including gender,gestational age,birth weight,age of admission,weight loss,blood type,premature rupture of membranes,amniotic fluid contamination,cranial hematoma,intrauterine infection,maternal pregnancy history and pregnancy complications,etc.Univariate analysis and multivariate Logistic regression analysis were used to analyze the risk factors of severe ABO HDN.Results The univariate analysis results showed that there were no significant differences in gender,gestational age,birth weight,weight loss,blood type,premature rupture of membrane,amniotic fluid pollution,hypertensive disorders in pregnancy,gestational diabetes mellitus and feeding methods between the two groups(P>0.05);there were statistically significant differences in the age of admission,cranial hematoma,intrauterine infection,maternal pregnancy history and cesarean section between the two groups(P<0.05).The multivariate Logistic regression analysis results showed that cranial hematoma,intrauterine infection,non-first pregnancy and cesarean section were risk factors for severe ABO HDN(P<0.05),and their odds ratio(OR)were 2.873,2.025,4.340 and 2.803 respectively.Conclusion Cranial hematoma,intrauterine infection,non-first pregnancy mothers and cesarean section are high risk factors for severe ABO HDN.For high risk pregnant women and newborns with high-risk factors,clinical identification and management should be strengthened,early diagnosis and treatment should be carried out to prevent the occurrence of severe ABO hemolysis and bilirubin encephalopathy.