新生儿急性胆红素脑病相关危险因素的meta分析

Risk factors associated with the acute bilirubin encephalopathy of neonates:a meta-analysis

目的:通过meta分析探讨新生儿急性胆红素脑病(ABE)的危险因素,为尽早识别和治疗ABE患儿提供理论依据。方法;检索万方数据库、中国知网、维普、PubmMed、Web of Science、Embase、Cochrane Library建库至2023年8月1日。按照纳入和排除标准筛选文献并提取相关数据,采用RevMan 5.3软件进行meta分析。结果:最终纳入30个临床研究,涉及12965名研究对象,共提取15个相关危险因素。meta分析显示,总胆红素峰值(OR=1.27,95%CI 1.21~1.34)、总胆红素/白蛋白比值(OR=1.47,95%CI 1.21~1.79)、24小时内黄疸(OR=6.03,95%CI 2.73~13.32)、ABO或Rh溶血(OR=3.31,95%CI 2.57~4.26)、血红蛋白水平高(OR=1.05,95%CI 1.01~1.11)、葡萄糖-6-磷酸脱氢酶缺乏(OR=3.82,95%CI 1.98~7.37)、围生期缺氧(OR=12.20,95%CI 1.95~76.27)、新生儿败血症(OR=3.13,95%CI 1.98~4.95)、感染(OR=4.99,95%CI 3.58~6.97)、代谢性酸中毒(OR=2.84,95%CI 1.64~4.91)、颅脑血肿(OR=4.17,95%CI 2.39~7.27)、出生体质量低(OR=3.31,95%CI:1.97~5.55)、出生后体质量下降(OR=1.08,95%CI:1.03~1.13)、母乳缺乏(OR=3.90,95%CI:1.97~7.74)、非医院出生(OR=2.59,95%CI 1.93~3.45)是新生儿ABE危险因素。结论:经文献分析分析出15个新生儿ABE危险因素,但仍需更多大样本、多中心、精确性的前瞻性研究进一步验证。

Objective:To explore the risk factors associated with the acute bilirubin encephalopathy(ABE)of neonates by a meta-analysis,and to provide the theoretical evidences for the early identification and treatment of the neonatal ABE.Methods:The relevant studies were retrieved from the databases of Wanfang Data,CNKI,VIP,PubMed,Web of Science,Embase and Cochrane Library from the establishment time of these databases to August 1,2023.The literatures were screened according to the inclusion and exclusion criteria,and the relevant data in the included literatures were extracted.The meta-analysis was performed by RevMan 5.3 software.Results:Finally,30 clinical studies were included in this meta-analysis,and which involving 12,965 neonates.The meta-analysis results showed that a total of 15 risk factors were identified.The peak value of the total serum bilirubin(OR=1.27,95%CI 1.21-1.34),the total serum bilirubin/albumin ratio(OR=1.47,95%CI1.21-1.79),the jaundice value within 24 hours(OR=6.03,95%CI 2.73-13.32),theABO or Rh hemolysis rate(OR=3.31,95%CI 2.57-4.26),the high level of hemoglobin(OR=1.05,95%CI 1.01-1.11),the glucose-6-phosphate ehydrogenase deficiency rate(OR=3.82,95%CI 1.98-7.37),the perinatal hypoxia rate(OR=12.20,95%CI1.95-76.27),the sepsis rate(OR=3.13,95%CI1.98-4.95),the infection rate(OR=4.99,95%CI3.58-6.97),the metabolic acidosis rate(OR=2.84,95%CI1.64-4.91),the cerebral hemato-ma rate(OR=4.17,95%CI 2.39-7.27),the low birth weight rate(OR=3.31,95%CI:1.97-5.55),the rate of weight loss after birth(OR=1.08,95%CI 1.03-1.13),the lack of breast milk rate(OR=3.90,95%CI 1.97-7.74),and the non-hospital birth rate(OR=2.59,95%CI:1.93-3.45)of the neonates were the risk factors for their ABE occurrence.Conclusion:The 15 factors based on this meta-analysis are the risk factors of the neonatal ABE occurrence.However,more prospective studies with large samples,multiple centers,and accuracy are still needed to conduct for further verifying these risk factors of the neonatal ABE occurrence.