新生儿感染性黄疸的临床特征及预后影响因素

Clinical characteristics and risk factors of prognosis in neonates with infectious jaundice

目的分析新生儿感染性黄疸的临床特征及预后。方法选择2018年1月-2021年1月在苏州市吴江区儿童医院住院的76例感染性黄疸患儿为研究组,另选同期70例非感染性黄疸患儿为对照组,对比两组患儿临床资料,根据治疗后黄疸消退时间将研究组患儿分为预后良好组(n=51)和预后不良组(n=25)。分析研究组患儿的临床特征,采用单因素及多因素Logistic回归分析新生儿感染性黄疸预后的影响因素。结果细菌培养共检出76株病原菌,革兰阳性菌以金黄色葡萄球菌感染为主,革兰阴性菌以大肠埃希菌感染为主;研究组患儿血清C-反应蛋白(CRP)、降钙素原(PCT)、经皮胆红素值(TcB)水平、肝功能损害、多脏器功能损害(MODS)和病情重度占比高于对照组,黄疸出现日龄早于对照组,病情轻度占比和新生儿行为神经评估(NBNA)评分低于对照组(P<0.05);治疗后,研究组患儿黄疸消退时间>5d占比高于对照组(P<0.05);预后良好患儿血清CRP、PCT、TcB水平、肝功能损害、病情重度占比及NBNA评分低于预后不良组(P<0.05);Logistic分析显示,CRP、PCT、TcB、合并肝功能损害、病情严重程度及NBNA评分均是感染性黄疸患儿预后不良的危险因素(P<0.05)。结论与非感染性黄疸患儿相比,感染性黄疸患儿机体炎症反应明显,病情更重,预后更差。血清CRP、PCT、TcB高表达、合并肝功能损害等可能与感染性黄疸患儿不良预后有关,临床应重视。

OBJECTIVE To analyze the clinical features and prognosis of neonatal infectious jaundice.METHODS A total of 76 children with infectious jaundice who were hospitalized in the Children's Hospital of Wujiang District from Jan 2018 to Jan 2021 were recruited as the observation group.During the same period,70 children with non-infectious jaundice were included in the control group.And the clinical data between the two groups were com-pared.According to the jaundice subsidence time after treatment,the children of the observation group was subdi-vided into the good prognosis group(n=51)and poor prognosis group(n=25).The clinical characteristics in the observation group was analyzed,and the prognostic factors of neonatal infectious jaundice were analyzed by univa-riate and multivariate logistic regression assay.RESULTS A total of 76 strains of pathogenic bacteria were isolated by bacterial culture.Gram-positive bacteria were mainly Staphylococcus aureus,and gram-negative bacteria were mainly Escherichia coli.Serum C-reactive protein(CRP),procalcitonin(PCT),transcutaneous bilirubin(TcB)levels,liver function damage,multiple organ dysfunction(MODS)and the proportion of severe disease in the ob-servation group were higher than those in the control group,while the age of jaundice emergence was smaller than that in the control group,and the proportion of mild disease and neonatal behavioral neurological assessment(NB-NA)scores were lower than those in the control group(P<0.05).After treatment,the proportion of children with jaundice subsided over five days in the observation group was higher than that in the control group(P<0.05).The proportion of severe disease and NBNA score in the good prognosis group were lower than those in the poor prognosis group(P<0.05).Multivariate logistic analysis showed that CRP,PCT,TcB,combined liver function damage,disease severity and NBNA score were all risk factors for poor prognosis of infectious jaundice(P<0.05).CONCLUSION Compared with children with non-infectious jaundice,children with infectious jaundice have more pronounced inflammatory responses,severer condition,and poorer prognosis.The high expression of serum CRP,PCT,TcB and liver function damage may be related to the poor prognosis of children with infectious jaundice,which should be paid attention to in clinical practice.