高原藏族新生儿高胆红素血症299例临床分析

Clinical Analysis of 299 Cases of Hyperbilirubinemiain Tibetan Neonateson Plateau

目的 分析该院近2年新生儿高胆红素血症的发生情况、胆红素峰值及病因,为高原新生儿胆红素研究提供数据,为新生儿胆红素血症的预防及规范化管理提供依据。方法 回顾性总结了自2019年1月—2021年7月以黄疸相关主诉就诊于西藏自治区人民医院儿科的藏族近足月儿(>35周),描述了胆红素峰值分布情况、不同胎龄间的比较、伴发症分析及脑病患儿特征描述。结果 299例新生儿高胆红素血症病例数据中严重高胆红素血症109例(36.5%),急性胆红素脑病病例6例,占严重高胆红素血症的5.5%.发现黄疸日龄4天(范围:1~26d),平均入院日龄7天(范围:1~30d),TSB峰值为342.45±65.23μmol/L。纳入病例中有91%伴有不同程度的感染,2例存在ABO自身免疫性溶血。结论 该研究数据展示了藏族近足月新生儿胆红素峰值分布情况,严重高胆红素血症患儿及脑病患儿的占比较高。因此,加大新生儿黄疸相关科普知识受众面,建立系统、全面的随访,为严重高胆红素血症的预防及规范化管理提供依据。

Objective To analyze the occurrence,peak bilirubin,and etiology of neonatal hyperbilirubinemia in our hospital in the past two years,to provide data for the study of high-altitude neonatal bilirubin,and to provide a basis for the prevention and standardized management of neonatal bilirubinemia.Methods The study retrospectively sum-marized the Tibetan near-term Tibetan infants(>35 weeks of gestation)who presented to the Department of Pediatrics of the People's Hospital of Xizang Autonomous Region from January 2019 to July 2021 with jaundice-related com-plaints,and described the distribution of bilirubin peaks,comparisons between different gestational ages,analysis of comorbidities,and characterization of children with encephalopathy.Results Among the 299 cases of neonatal hyper-bilirubinemia,109 cases(35.8%)were severe hyperbilirubinemia and 6 cases of acute bilirubinous encephalopathy,accounting for 5.7%of severe hyperbilirubinemia.The age of jaundice was 4 days(range:1~26 days),the average age of admission was 7 days(range:1~30 days),and the peak TSB was 342.45±65.23μmol/L.Ninety-one percent of the included cases had varying degrees of infection,and two had ABO autoimmune hemolysis.Conclusion The data of this study showed the peak distribution of bilirubin in Tibetan near-term neonates,and the proportion of infants with severe hyperbilirubinemia and encephalopathy was relatively high,suggesting that the audience of neonatal jaundice related scientific knowledge should be expanded,and a systematic and comprehensive follow-up should be established to provide a basis for the prevention and standardized management of severe hyperbilirubinemia.