AIM To describe the etiology and characteristics of earlyonset conjugated hyperbilirubinemia(ECHB) presenting within 14 d of life in term neonates.METHODS Retrospective review was performed of term infants up to 28-d-...AIM To describe the etiology and characteristics of earlyonset conjugated hyperbilirubinemia(ECHB) presenting within 14 d of life in term neonates.METHODS Retrospective review was performed of term infants up to 28-d-old who presented with conjugated hyperbilirubinemia(CHB) at a tertiary center over a 5-year period from January 2010 to December 2014. CHB is defined as conjugated bilirubin(CB) fraction greater than 15% of total bilirubin and CB greater or equal to 25 μmol/L. ECHB is defined as CHB detected within 14 d of life. "Late-onset" CHB(LCHB) is detected at 15-28 d of life and served as the comparison group.RESULTS Total of 117 patients were recruited: 65 had ECHB, 52had LCHB. Neonates with ECHB were more likely to be clinically unwell(80.0% vs 42.3%, P < 0.001) and associated with non-hepatic causes(73.8% vs 44.2%, P = 0.001) compared to LCHB. Multifactorial liver injury(75.0%) and sepsis(17.3%) were the most common causes of ECHB in clinically unwell infants, majority(87.5%) had resolution of CHB with no progression to chronic liver disease. Inborn errors of metabolism were rare(5.8%) but associated with high mortality(100%) in our series. In the subgroup of clinically well infants(n = 13) with ECHB, biliary atresia(BA) was the most common diagnosis(61.5%), all presented initially with normal stools and decline in total bilirubin but with persistent CHB. CONCLUSION Secondary hepatic injury is the most common reason for ECHB. BA presents with ECHB in well infants without classical symptoms of pale stools and deep jaundice.展开更多
目的分析高胆红素血症患儿新生儿溶血病(hemolytic disease of newborn,HDN)血清学检测结果并探讨与其相关因素之间的关系。方法对796例高胆红素血症患儿的血样进行新生儿溶血三项试验,并分析HDN阳性率与血型、送检日龄、血红蛋白水平...目的分析高胆红素血症患儿新生儿溶血病(hemolytic disease of newborn,HDN)血清学检测结果并探讨与其相关因素之间的关系。方法对796例高胆红素血症患儿的血样进行新生儿溶血三项试验,并分析HDN阳性率与血型、送检日龄、血红蛋白水平及血清总胆红素值等因素的关系。结果 796例高胆红素血症患儿中HDN患儿184例(23.12%),其中ABOHDN 176例,Rh-HDN 8例。796例患儿血样检测结果中游离试验阳性180例(22.61%),释放试验阳性184例(23.12%),直抗试验阳性140例(17.59%)。B型血患儿HDN阳性率高于A型血患儿,差异有统计学意义(χ2=10.30,P<0.05)。HDN阳性率与送检日龄密切相关,且日龄越大阳性检出率越低,差异有统计学意义(P<0.05)。184例HDN阳性患儿血红蛋白水平及血清总胆红素值与HDN患儿差异有统计学意义(P<0.05)。结论高胆红素血症患儿HDN阳性率较高,应尽早进行溶血三项试验,并可结合血红蛋白水平及血清总胆红素值来提高HDN检出率。展开更多
目的:探讨分析母婴血型不合患儿新生儿溶血病(hemolytic disease of newborn,HDN)检测结果及其与患儿间接胆红素(indirect bilirubin,IBIL)之间的关系。方法:选取2020年1月至2021年1月云南省第三人民医院收治的其母亲血型为O型RhD阳性...目的:探讨分析母婴血型不合患儿新生儿溶血病(hemolytic disease of newborn,HDN)检测结果及其与患儿间接胆红素(indirect bilirubin,IBIL)之间的关系。方法:选取2020年1月至2021年1月云南省第三人民医院收治的其母亲血型为O型RhD阳性的新生儿血液标本行血型鉴定,并用微柱凝胶试验技术做直接抗人球蛋白试验(direct anti human globulin test,DAT)、红细胞抗体放散试验(放散试验)、血清游离抗体试验(游离试验),根据试验结果判定患儿是否发生ABO溶血,并监测患儿IBIL变化。结果:选取的141例标本中,HDN检测结果阳性101例,可疑阳性2例,阴性38例,HDN阳性患儿IBIL明显高于阴性患儿,差异有统计学意义(P<0.05)。A型患儿77例,HDN阳性62例,阳性率80.52%;B型患儿62例,HDN阳性39例,阳性率62.90%。A型患儿HDN阳性率明显高于B型患儿,差异有统计学意义(P<0.05)。日龄<1 d患儿33例,阳性率51.52%;日龄1~3 d患儿78例,阳性率88.46%;日龄4~6 d患儿16例,阳性率68.75%;日龄≥7 d患儿14例,阳性率28.57%;可见行HDN检测时间越晚的患儿,IBIL越高,而患儿1~3 d时HDN阳性检测率最高,差异有统计学意义(P<0.05)。在HDN阳性患儿中有93例进行了静脉注射丙种球蛋白治疗,比较丙种球蛋白治疗前后的IBIL,发现治疗后患儿IBIL(120.988±31.104)μmol/L明显较治疗前(190.055±63.687)μmol/L低,差异有统计学意义(P<0.05)。结论:A型患儿比B型患儿更易发生新生儿ABO溶血病。采血时间越早HDN检出率越高,采血时间越晚患儿IBIL越高,应尽早行HDN检测,并及时进行丙种球蛋白治疗。展开更多
文摘AIM To describe the etiology and characteristics of earlyonset conjugated hyperbilirubinemia(ECHB) presenting within 14 d of life in term neonates.METHODS Retrospective review was performed of term infants up to 28-d-old who presented with conjugated hyperbilirubinemia(CHB) at a tertiary center over a 5-year period from January 2010 to December 2014. CHB is defined as conjugated bilirubin(CB) fraction greater than 15% of total bilirubin and CB greater or equal to 25 μmol/L. ECHB is defined as CHB detected within 14 d of life. "Late-onset" CHB(LCHB) is detected at 15-28 d of life and served as the comparison group.RESULTS Total of 117 patients were recruited: 65 had ECHB, 52had LCHB. Neonates with ECHB were more likely to be clinically unwell(80.0% vs 42.3%, P < 0.001) and associated with non-hepatic causes(73.8% vs 44.2%, P = 0.001) compared to LCHB. Multifactorial liver injury(75.0%) and sepsis(17.3%) were the most common causes of ECHB in clinically unwell infants, majority(87.5%) had resolution of CHB with no progression to chronic liver disease. Inborn errors of metabolism were rare(5.8%) but associated with high mortality(100%) in our series. In the subgroup of clinically well infants(n = 13) with ECHB, biliary atresia(BA) was the most common diagnosis(61.5%), all presented initially with normal stools and decline in total bilirubin but with persistent CHB. CONCLUSION Secondary hepatic injury is the most common reason for ECHB. BA presents with ECHB in well infants without classical symptoms of pale stools and deep jaundice.
文摘目的:探讨分析母婴血型不合患儿新生儿溶血病(hemolytic disease of newborn,HDN)检测结果及其与患儿间接胆红素(indirect bilirubin,IBIL)之间的关系。方法:选取2020年1月至2021年1月云南省第三人民医院收治的其母亲血型为O型RhD阳性的新生儿血液标本行血型鉴定,并用微柱凝胶试验技术做直接抗人球蛋白试验(direct anti human globulin test,DAT)、红细胞抗体放散试验(放散试验)、血清游离抗体试验(游离试验),根据试验结果判定患儿是否发生ABO溶血,并监测患儿IBIL变化。结果:选取的141例标本中,HDN检测结果阳性101例,可疑阳性2例,阴性38例,HDN阳性患儿IBIL明显高于阴性患儿,差异有统计学意义(P<0.05)。A型患儿77例,HDN阳性62例,阳性率80.52%;B型患儿62例,HDN阳性39例,阳性率62.90%。A型患儿HDN阳性率明显高于B型患儿,差异有统计学意义(P<0.05)。日龄<1 d患儿33例,阳性率51.52%;日龄1~3 d患儿78例,阳性率88.46%;日龄4~6 d患儿16例,阳性率68.75%;日龄≥7 d患儿14例,阳性率28.57%;可见行HDN检测时间越晚的患儿,IBIL越高,而患儿1~3 d时HDN阳性检测率最高,差异有统计学意义(P<0.05)。在HDN阳性患儿中有93例进行了静脉注射丙种球蛋白治疗,比较丙种球蛋白治疗前后的IBIL,发现治疗后患儿IBIL(120.988±31.104)μmol/L明显较治疗前(190.055±63.687)μmol/L低,差异有统计学意义(P<0.05)。结论:A型患儿比B型患儿更易发生新生儿ABO溶血病。采血时间越早HDN检出率越高,采血时间越晚患儿IBIL越高,应尽早行HDN检测,并及时进行丙种球蛋白治疗。
