执行2014《新生儿高胆红素血症诊断和治疗专家共识》后单中心新生儿高胆红素血症诊疗现状

Diagnosis and treatment of neonatal hyperbilirubinemia after the implementation of expert consensus in 2014:a single-center experience

目的探讨执行2014《新生儿高胆红素血症诊断和治疗专家共识》后单中心新生儿高胆红素血症的诊疗现状。方法回顾性收集2021年1~12月广州医科大学附属妇女儿童医疗中心妇婴院区收治的新生儿高胆红素血症患儿资料,以2014《新生儿高胆红素血症诊断和治疗专家共识》为基础,分析入选患儿入院经皮胆红素(transcutaneous bilirubin,TCB)、血清总胆红素(total serum bilirubin,TSB)、达光疗阈值率,光疗前静脉取血率,丙种球蛋白、白蛋白使用率,出院前停光疗时间,出院TCB、TSB与光疗阈值的差值等,并根据胎龄和高危因素将入选患儿分为低危组、中危组和高危组,比较不同危险度高胆红素血症患儿的相关指标。结果共纳入421例患儿,早产儿18例(4.3%);生后24 h内出现黄疸173例(41.1%);低危组193例、中危组213例、高危组15例。入院后首次TCB达光疗阈值364例(86.5%),TSB达光疗阈值237例(56.3%),光疗前静脉取血18例(4.3%);合并ABO溶血101例(24.0%),14例给予丙种球蛋白治疗,无低白蛋白血症及使用白蛋白治疗的患儿;住院期间光疗时间24(18,38)h,出院前停光疗时间59(41,72)h,停光疗48~72 h出院占比最多,为194例(46.1%);出院前TCB、TSB分别低于光疗阈值(140.8±51.6)、(142.6±40.1)μmol/L。与低危组相比,中危组和高危组胎龄更低、出生24 h内出现黄疸的比例更高、首次住院时间更早,光疗时间、出院前停光疗时间和住院时间均更长(P<0.05)。结论新生儿高胆红素血症患儿光疗前静脉取血比例低,需加强,以便准确反映入院时的TSB。中高危患儿黄疸出现早、持续时间长,应重视早期监测及处理。

Objective To study the changes of clinical practices in our hospital after the implementation of"expert consensus on diagnosis and treatment of neonatal hyperbilirubinemia in 2014"(the Consensus).Methods From January 2021 to December 2021,infants with neonatal hyperbilirubinemia hospitalized in our hospital were enrolled.Based on the Consensus,the following were analyzed:transcutaneous bilirubin(TCB)and total serum bilirubin(TSB)on admission,the incidences of TCB/TSB above phototherapy thresholds,pre-phototherapy intravenous blood sampling,IVIG/albumin usage,the gap between phototherapy cessation and discharge,and the differences between TCB/TSB and phototherapy threshold at discharge.The infants were assigned into low-,moderate-and high-risk groups according to gestational age(GA)and risk factors,and the differences among these groups were compared.Results A total of 421 infants were enrolled,including 18 preterm infants(4.3%)and 173(41.1%)early-onset jaundice(within 24 h after birth).193 cases were in low-risk group,213 moderate-risk group and 15 high-risk group.For the first testing after admission,364(86.5%)TCB and 237(56.3%)TSB were above phototherapy thresholds.18 cases(4.3%)received intravenous blood sampling prior to phototherapy.101 cases(24.0%)had ABO hemolysis and 14 cases received IVIG therapy.No low albuminemia nor albumin treatment were observed.The duration of phototherapy was 24(18,38)h.The gap between phototherapy cessation and discharge was 59(41,72)h,mostly(194 cases,46.1%)48~72 h.Before discharge,TCB and TSB levels were(140.8±51.6)and(142.6±40.1)μmol/L lower than the threshold.Comparing with low-risk group,both moderate-and high-risk groups had lower GA,higher incidences of jaundice within 24 h after birth,earlier hospitalization,longer durations of phototherapy,bigger gap between phototherapy cessation and discharge and longer hospital stay(P<0.05).Conclusions For infants with neonatal hyperbilirubinemia,the incidence of intravenous blood sampling before phototherapy is inadequately low and needs to be enhanced to accurately detect TSB on admission.Moderate-and high-risk groups have early onset and longer durations of jaundice and warrant early monitoring and management.