Genetic variation features of neonatal hyperbilirubinemia caused by inherited diseases

BACKGROUND Genetic factors play an important role in neonatal hyperbilirubinemia(NH)caused by genetic diseases.AIM To explore the characteristics of genetic mutations associated with NH and analyze the correlation with genetic diseases.METHODS This was a retrospective cohort study.One hundred and five newborn patients diagnosed with NH caused by genetic diseases were enrolled in this study between September 2020 and June 2023 at the Second Affiliated Hospital of Xiamen Medical College.A 24-gene panel was used for gene sequencing to analyze gene mutations in patients.The data were analyzed via Statistical Package for the Social Sciences 20.0 software.RESULTS Seventeen frequently mutated genes were found in the 105 patients.Uridine 5'-diphospho-glucuronosyltransferase 1A1(UGT1A1)variants were identified among the 68 cases of neonatal Gilbert syndrome.In patients with sodium taurocholate cotransporting polypeptide deficiency,the primary mutation identified was Na+/taurocholate cotransporting polypeptide Ntcp(SLC10A1).Adenosine triphosphatase 7B(ATP7B)mutations primarily occur in patients with hepatolenticular degeneration(Wilson's disease).In addition,we found that UGT1A1 and glucose-6-phosphate dehydrogenase mutations were more common in the high-risk group than in the low-risk group,whereas mutations in SLC10A1,ATP7B,and heterozygous 851del4 mutation were more common in the low-risk group.CONCLUSION Genetic mutations are associated with NH and significantly increase the risk of disease in affected newborns.

Unique presentation of neonatal liver failure:A case report

BACKGROUND Acute fulminant liver failure rarely occurs in the neonatal period.The etiologies include viral infection(15%),metabolic/genetic disease(10%),hematologic disorders(15%),and ischemic injury(5%).Gestational alloimmune liver disease usually manifests as severe neonatal liver failure,with extensive hepatic and extrahepatic iron overload,sparing the reticuloendothelial system.Empty liver failure is a rare cause of liver failure where a patient presents with liver failure in the neonatal period with no hepatocytes in liver biopsy.CASE SUMMARY A 5-week-old male presented with jaundice.Physical examination revealed an alert but deeply icteric infant.Laboratory data demonstrated direct hyperbilirubinemia,a severely deranged coagulation profile,normal transaminase,and normal ammonia.Magnetic resonance imaging of the abdomen was suggestive of perinatal hemochromatosis.Liver biopsy showed histiocytic infiltration with an absence of hepatocytes.No hemosiderin deposition was identified in a buccal mucosa biopsy.CONCLUSION Neonatal liver failure in the absence of hepatocellular regeneration potentially reflects an acquired or inborn defect in the regulation of hepatic regeneration.

Clinical features and genetic variations of severe neonatal hyperbilirubinemia:Five case reports

BACKGROUND Neonatal hyperbilirubinemia is a common problem faced by pediatricians.The role of genetic factors in neonatal jaundice has been gradually recognized.This study aims to identify genetic variants that influence the bilirubin level in five patients using next-generation sequencing(NGS).CASE SUMMARY Five neonates with severe hyperbilirubinemia were retrospectively studied.They exhibited bilirubin encephalopathy,hypothyroidism,ABO blood type incompatibility hemolysis,glucose-6-phosphate dehydrogenase(G6PD)deficiency and premature birth,respectively.A customized 22-gene panel was designed,and NGS was carried out for these neonates.Eight variations(G6PD c.G1388A,HBA2 c.C369G,ABCC2 c.C3825G,UGT1A1 c.G211A,SPTB c.A1729G,EPB41 c.G520A,c.1213-4T>G and c.A1474G)were identified in these five neonates.Genetic mutations of these genes are associated with G6PD deficiency,thalassemia,Dubin-Johnson syndrome,Gilbert syndrome,hereditary spherocytosis,and hereditary elliptocytosis.One of the neonates was found to have compound variants of the EPB41 splice site c.1213-4T>G and c.G520A(p.E174K),but no elliptocyte was seen on his blood smear of 4 years old.CONCLUSION Pathological factors of severe neonatal hyperbilirubinemia are complicated.Genetic variants may play an important role in an increased risk of neonatal hyperbilirubinemia,and severe jaundice in neonates may be related to a cumulative effect of genetic variants.

Semi-Quantitative Analysis of Brain MR Imaging in 76 Cases of Neonatal Indirect Hyperbilirubinemia

Background: Neonatal hyperbilirubinemia is indeed common. However, severe nerve injuries and bilirubin encephalopathy are rare and only occur in the unusual cases of extreme hyperbilirubinemia. Objectives: To investigate brain magnetic resonance imaging (MRI) changes and their correlations with perinatal predisposing factors in neonates with indirect hyperbilirubinemia, via regions of interest (ROIs) analysis. Methods: Seventy-six neonates with a gestational age of ≥35 weeks diagnosed with neonatal indirect hyperbilirubinemia or bilirubin encephalopathy all underwent brain MRI during hospitalization. Depending on peak total serum bilirubin (TSB), they were assigned to group A (<221 μmol/L), B (≥221 μmol/L μmol/L), C (≥42 μmol/L μmol/L), or D (≥428 μmol/L). The globus pallidus and the white matter around the anterior horn of the lateral ventricle and posterior horn of the lateral ventricle were selected as the ROIs. Average optical densities (AODs) of the ROIs and the cerebrospinal fluid region were measured. The ratio between the AODs was designated as the relative optical density (ROD), and used to determine relative signal intensity. Results: RODs of the globus pallidus were significantly lower in group D than in all other groups. TSB and the ratio of TSB to serum albumin concentration (B/A) was significantly negatively correlated with ROD in theglobus pallidus. Corrected age was significantly negatively correlated with the ROD of the ROIs. Conclusions: Semi-quantitative image analysis is a feasible method to assess conventional brain MRI for neonatal indirect hyperbilirubinemia. The signal intensity of the globus pallidus in T1-weighted images was significantly correlated with TSB level and B/A.

Effect of ursodeoxycholic acid combined with bifidobacterium quadruple preparations on myocardial enzyme, immune function and inflammatory response of hyperbilirubinemia neonatal

Objective: To investigate the effects of myocardial enzyme, immune function and inflammatory response by ursodeoxycholic acid combined with bifidobacterium quadruple preparations on hyperbilirubinemia neonatal. Methods: A total of 100 cases of neonatal hyperbilirubinemia in our hospital from June 2016 to May-2017 were selected and divided into control group and observation group by random number table, 50 cases in each group. Two groups of neonatal were given routine symptomatic treatment. The control group was treated with ursodeoxycholic acid and the observation group was treated with Bifidobacterium tetralogy of live bacteria on the basis of the control group. The two groups of neonatal were both treated for 7 d. The serum levels of CK-MB, CK, LDH, AST, CD3+, CD4+, CD4+/CD8+, CD8+, CRP and TNF-α were measured before and after the treatment of the two groups. Results: Before treatment, there was no significant difference in serum CK-MB, CK, LDH, AST, CD3+, CD4+, CD4+/CD8+, CD8+, CRP and TNF-α levels between the 2 groups. After treatment: 2 groups of serum CK-MB, CK, LDH, AST, CD8+, CRP, TNF-α levels significantly decreased compared with the group before treatment, CD3+, CD4+ and CD4+/CD8+ levels were significantly increased after treatment, and the observation group with serum CK-MB, CK, LDH, AST, CD8 +, CRP, TNF-α levels were significantly lower than the control group, CD3+, CD4+ and CD4+/CD8+ levels were significantly higher than the control group, the differences were statistically significant. Conclusion: Ursodeoxycholic acid combined with Bifidobacterium quadruple viable tablets can can reduce the activity of myocardial enzyme, improve the state of spectrum index of neonatal hyperbilirubinemia.

Conjugated hyperbilirubinemia presenting in first fourteen days in term neonates

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.

Neonatal Bilirubin Encephalopathy: Study of 30 Cases at Albert Royer National Children Hospital of Dakar

Introduction: Unconjugated bilirubin jaundice is a common symptom in neonatal period. In some babies, excessive serum bilirubin concentrations can place them at risk of acute bilirubin encephalopathy (BE) when the unconjugated pigment crosses the blood-brain barrier. Our study aimed to describe epidemiology, diagnosis and prognosis of BE at the Neonatology Department of Albert Royer Children’s Hospital of Dakar. Materials and Methods: It was a retrospective, descriptive study of cases of BE from January 1, 2015 to June 30, 2019. Obstetric and perinatal data as well as postnatal jaundice data (onset time, associated signs, signs of encephalopathy, treatment and evolution) were collected and analyzed by SPSS software version 2.0. Almost all newborns (27 cases;90%) were exclusively breastfed. At admission, all children exhibited blunt jaundice and signs of encephalopathy dominated by the abolition of archaic reflexes (76.7%), low suction (22 cases;73.3%), central apnea (12 cases, 40%). The mean serum bilirubinemia was 322 mg/litre. Neonatal infection (10 cases;33.3%) and fetal-maternal incompatibility (16 cases;53.3%) were the main causes. All children received intensive phototherapy and exsanguino transfusion was performed for 7 newborns (23.3%). Nine children died (30% mortality rate). Conclusion: Only better organisation of perinatal care with enhanced postnatal follow-up can reduce the incidence of EB.

Characteristics of brainstem auditory evoked potential of neonates with mild or moderate hyperbilirubinemia

BACKGROUND： Brainstem auditory evoked potential （BAEP） has been widely used to evaluate the functional integrity and development of injured auditory system and brain, especially to objectively evaluate the function of auditory system and brain stem of very young babies, such as neonates and sick babies. OBJECTIVE： To observe the changes of BAEP of neonates with hyperbilirubinemia, and to investigate the relationship of bilirubin concentration and BAEP. DESIGN： An observation experiment. SETTING： Department of Pediatrics, the 309 Clinical Division, General Hospital of Chinese PLA. PARTICIPANTS： Fifty-eight neonates with mild or moderate hyperbilirubinemia exhibiting jaundice within 24 hours after born, who received the treatment in the Department of Pediatrics, the 309 Clinical Division, General Hospital of Chinese PLA between January 2004 and May 2007, were recruited in this study. The involved neonates, 31 boys and 27 girls, had gestational age of 37 to 46 weeks. They had no history of birth asphyxia, and were scored 8 to 10 points when born. Written informed consents of examination and treatment were obtained from the guardians of the neonates. This study was approved by the Hospital Ethics Committee. According to serum total bilirubin value, the neonates were assigned into 3 groups： low-concentration bilirubin group （n =16）, moderate-concentration bilirubin group （n =27） and high-concentration bilirubin group （n =15）. According to mean daily bilirubin increase, the subjects were sub-assigned into bilirubin rapid increase group （n =39） and bilirubin slow increase group （n = 19）. METHODS： After admission, all the neonates received drug treatment. Meanwhile, their 116 ears were examined with a myoelectricity evoked potential equipment （KEYPOINT） in latency, wave duration, amplitude and wave shape differentiation of each wave of BAEP. BAEP abnormal type was observed and abnormal rate of BAEP was calculated. MAIN OUTCOME MEASURES： ①Abnormal rate and abnormal type of BAEP. ② Latency of waves Ⅰ , Ⅲ and Ⅴ, and wave duration of waves Ⅰ to Ⅲ,Ⅲ to Ⅴ, and Ⅰ to Ⅴ. RESULTS： Fifty-eight neonates with mild or moderate hyperbilirubinemia were involved in the final analysis. ①Abnormal type and abnormal rate of BAEP of neonates with hyperbilirubinemia： Among the 116 ears, unilateral or bilateral waves Ⅰ, Ⅲ,Ⅴ still existed. The latency of waves Ⅰ, Ⅲ and Ⅴ was ＋2.5 s longer than the normal level in 8, 4 and 15 ears, respectively. The wave duration of waves Ⅰ to Ⅲ and waves Ⅲ to Ⅴ was ＋2.5 s longer than the normal level in 6 and 14 ears, respectively. The wave duration of waves Ⅲ to Ⅴ was longer than that of ipsilateral waves Ⅰ to Ⅲ in 24 ears. The latency difference of wave Ⅴ between two ears was larger than 0.4 ms in 31 neonates with hyperbilirubinemia; The amplitude of wave Ⅴ to that of ipsilateral wave 1 was lower than 0.5 in 29 neonates. Totally 52 ears were abnormal, and the abnormal rate was 44.8%. One to two months later, 98% abnormal neonates with hyperbilirubinemia recovered. The abnormal rate in the low-, moderate-, and high-concentration bilirubin groups was 37.5%, 44.4% and 53.3%, respectively. ② Comparison of latency and wave duration of each wave of BAEP： Latency of waves Ⅰ, Ⅲ and Ⅴ, and wave duration of waves Ⅰ to III and Ⅲ to Ⅴ were gradually prolonged in low-, moderate-, and high-concentration bilirubin groups, but significant difference did not exist between two groups （P 〉 0.05）. ③ There were no significant differences in latency of waves Ⅰ, Ⅲand Ⅴ, and wave duration of waves Ⅰ to Ⅲ, Ⅲto Ⅴ and Ⅰ to Ⅴ between bilirubin rapid increase group and bilirubin slow increase group （P 〉 0.05）. CONCLUSION： Auditory acuity and brainstem of neonates with mild or moderate hyperbilirubinemia are damaged to some extent. High-concentration bilirubin causes BAEP abnormality easily. Bilirubin increase and its concentration change are not consistent with nervous lesion degree.

The Effect of Pomegranate Paste on Neonatal Jaundice Incidence: A Clinical Trial in Women during Pregnancy

Purpose: Some topics such as women’s life style and nutrition and using some special medicines during pregnancy have been discussed and demonstrated as effective factors on infant’ health. Based on recommendations in Iranian traditional medicine, we aimed to evaluate the efficacy of pomegranate paste consumed by women during their pregnancy on the neonatal jaundice incidence. Methods: In this single-blinded controlled clinical trial, 80 healthy pregnant women were randomly divided into 2 groups, as treatment and control. The treatment group members added pomegranate paste to their daily diet from the 34th week of the pregnancy to birth, as administered. The levels of neonates’ bilirubin were checked in the 5th day of the delivery. Results: Both the need of phototherapy and the mean level of neonates’ bilirubin in the group fed with pomegranate paste were significantly lesser compared to control group. The number of neonates who were undergone phototherapy in the pomegranate paste receiving group was significantly lesser than that in the control group (P value = 0.029). By measuring the total bilirubin, statically significant difference between the treatment group and the control group was seen (P value = 0.021). Conclusion: The results of this study suggest the possible effect of adding pomegranate paste to pregnant women’s diet on the incidence of neonatal jaundice.

Incidence and Risk Factors to Neonatal Jaundice in Jalingo, Taraba State

This cross-sectional study was aimed to determine the incidence and the significant risk factors to neonatal jaundice in FMC, Jalingo. Four hundred and thirty three neonates admitted to special baby care unit (SBCU) FMC, Jalingo with their mothers were surveyed. Data were collected through a data extraction format looking on the medical records of the neonates (from 1st January, 2021 to 31st August, 2021) and interviewing the mothers. Data were transferred to an Excel data sheet and results were summarized by frequencies and percentages (categorical variables). Logistic regression analysis was used to determine the strength of the risk factors to neonatal jaundice while the significance was tested at p-value ≤ 0.05. The findings revealed that the incidence of neonatal jaundice in FMC Jalingo was 40.18% while the significant risk factors were age group 41 - 50 years (I = 15.01%, OR: 2.970 at 95% CI: 1.566 - 5.634, p = 0.000), spontaneous vaginal delivery (I = 18.01%, OR: 1.382 at 95% CI: 0.940 - 2.033, p = 0.000), premature rupture of membrane (I = 24.94%, OR at: 2.252 at 95% CI: 1.520 - 3.337, p = 0.000), hypertension in pregnancy (I = 21.02%, OR: 1.831 at 95% CI: 1.240 - 2.703, p = 0.002). Others were breech fetal presentation (I = 23.33%, OR: 2.689 at 95% CI: 1.809 - 3.995, p = 0.000), birth asphyxia (I = 22.40%, OR: 3.469 at 95% CI: 2.3105.210, p = 0.000), significant bruising (I = 22.86%, OR: 1.705 at 95% CI: 1.157 - 2.513, p = 0.007), neonatal sepsis (I = 21.02%, OR: 1.688 at 95% CI: 1.145 - 2.488, p = 0.008) and congenital hemolytic anemia (I = 21.71%, OR: 1.723 at 95% CI: 1.169 - 2.540, p = 0.006). Therefore, the need for all concerned to ensure the incidence is reduced and the risk factors identified early and tackled.

Neonatal Graves’ Disease and Cholestatic Jaundice: Case Series and Review of the Literature

Cholestatic jaundice and elevated liver enzymes are uncommon, but recognized, manifestations of neonatal thyrotoxicosis. Current guidelines for evaluation of cholestatic jaundice and reviews in Neonatology literature do not discuss hyperthyroidism in the differential diagnosis of cholestatic jaundice. We report two cases of neonatal thyrotoxicosis secondary to neonatal Graves’ disease that presented with cholestatic jaundice and elevated liver enzymes at birth. Early recognition of thyrotoxicosis as a cause of the hepatic disease in the neonate is crucial to prevent unnecessary diagnostic procedures and to initiate timely treatment.

熊去氧胆酸治疗新生儿高胆红素血症的文献分析

目的Meta分析熊去氧胆酸(ursodeoxycholic acid,UDCA)治疗新生儿高胆红素血症的临床疗效。方法在中国知网、万方、维普、Pub Med/MEDLINE及Scopus等中英文数据库中检索,筛选出2010—2023年期间有关UDCA用于高胆红素血症新生儿治疗的随机对照试验,对文献质量评价,提取相关文献研究资料,采用Review Manager 5.4统计软件对筛选出的文献进行Meta分析,以探讨UDCA联合蓝光治疗新生儿高胆红素血症的临床疗效。结果筛出符合研究的6篇随机临床试验文献,包括1篇中文与5篇英文文献。文献中的对照组新生儿总计371例,均行蓝光照射疗法;试验组总计439例,均行UDCA+蓝光照射疗法。文献的I2值均>50%且P值均<0.10时,表示存在异质性,采用随机效应模型;经Meta分析,试验组新生儿在治疗后不同时间段的总胆红素水平均明显低于对照组(P<0.05);且试验组光疗持续时间也明显短于对照组(MD=-19.15,95%CI:-20.80~-17.50,P<0.01)。结论相较于传统的蓝光疗法,联合UDCA治疗能进一步促进高胆红素血症患儿的胆红素水平下降,缩短光疗时间。

高原藏族新生儿高胆红素血症299例临床分析

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。

近15年新生儿高胆红素血症研究的文献计量学及可视化分析

目的:对近15年新生儿高胆红素血症的相关研究进行文献计量学及可视化分析,探讨其研究现状和热点前沿,为该领域以后的研究提供一定参考.方法:检索2009年1月至2024年1月收录的新生儿高胆红素血症的相关文献1746篇供本研究分析,以Web of Science(WOS)核心合集为文献来源,使用VOSviewer和CiteSpace软件对国家、期刊、关键词等进行分析,并生成图表.结果:分析得出发文量最多的国家是美国,发文量最多且共被引最多的期刊是PEDIATRICS;关键词分析发现光疗、核黄疸、经皮测胆红素、换血疗法等是出现频数较高的关键词.结论:近15年研究热点主要集中于病因、发病机制和治疗等方面,并逐渐细化,推测未来会得到持续关注.

茵栀黄口服液联合间断蓝光照射治疗新生儿高胆红素血症的临床效果分析

目的探讨茵栀黄联合间断蓝光治疗新生儿高胆红素血症的临床疗效。方法简单随机选取2021年1月—2022年12月丰县人民医院收治的新生儿病理性黄疸100例为研究对象,根据随机数表法分成两组,各50例,对照组采取蓝光治疗,观察组采取蓝光联合茵栀黄治疗,比较两组临床疗效、中医症候评分、血清胆红素水平及不良反应发生率。结果观察组疗效为96.00%,高于对照组的80.00%,差异有统计学意义(χ^(2)=4.640,P=0.031);治疗后,观察组的血清的中医症候评分低于对照组,差异有统计学意义(P<0.05)。观察组患者治疗后的血清胆红素水平低于对照组,差异有统计学意义(P<0.05);治疗期间两组的不良反应的发生率比较,差异无统计学意义(P>0.05)。结论茵栀黄口服液联合间断蓝光照射治疗新生儿高胆红素血症可提高治疗效果,促进胆红素排泄,改善临床症状,且安全性高。

鸢尾素对新生大鼠高胆红素血症细胞凋亡的影响

目的:探究鸢尾素对新生大鼠高胆红素血症细胞凋亡的影响。方法:将96只新生SD大鼠随机分为对照组(N组)和模型组(M组),于7和10日龄腹腔注射胆红素溶液进行造模。造模成功后将M组随机分为T0组、T1组、T2组、T3组。T1、T2、T3组分别侧脑室注射40、60和80μg/kg的鸢尾素溶液,余各组注射等量磷酸盐缓冲液溶液。侧脑室注射24h后,神经行为学、苏木精-伊红染色(Hematoxylin-Eosin staining,HE)、原位末端标记法(terminal-deoxynucleoitidyl transferase mediated nick end labeling,Tunel)检测海马区病理改变并统计凋亡率,Western Blot检测海马Bcl-2、Bax和Caspase-3蛋白相对表达量。结果:侧脑室注射鸢尾素后。平面翻正反射:T3组所需时间少于T0、T1、T2组且多于N组(P<0.01);负趋地性反射:T3组所需时间少于T0、T1、T2组(P<0.01,P<0.05)。HE染色:M组海马神经细胞核固缩、裂解,排列紊乱。T1、T2、T3组细胞形态等不同程度改善。Tunel染色:M组Tunel+细胞增多,布满视野;N组Tunel+细胞少,呈零星分布;T3组凋亡率低于T0、T1组(P<0.05)。Western Blot:各组Bcl-2蛋白相对表达量无显著性意义(P>0.05);T0组Bax蛋白高于其余各组(P<0.05),T3组低于T1组(P<0.05);T0组Bcl-2/Bax值低于N、T3组(P<0.05),T1、T2组均低于T3组(P<0.05);T0组Caspase-3蛋白高于其余各组(P<0.05),N组低于T1组(P<0.05),T1组高于T3组(P<0.05)。结论:鸢尾素可能通过减少Bax、Caspase-3蛋白表达,升高Bcl-2/Bax值来减轻神经细胞凋亡且与鸢尾素注射剂量相关。

目标管理理论的护理模式在新生儿高胆红素血症患儿中的应用

目的探讨目标管理理论的护理模式在新生儿高胆红素血症患儿中的应用效果。方法选取2021年1月至2023年1月郑州大学附属儿童医院94例新生儿高胆红素血症患儿,按入院顺序分为目标管理组(47例)、常规组(47例)。常规组男25例,女22例,胎龄36~42(39.03±1.07)周。目标管理组男21例,女26例,胎龄36~42(38.94±1.12)周。常规组实施常规护理,目标管理组在常规组基础上实施目标管理理论的护理模式,两组均干预至患儿病情恢复。比较两组干预前后血清胆红素水平、睡眠时间[简明婴儿睡眠问卷(Brief Infant Sleep Questionnaire,BISQ)]及黄疸消退时间、不适症状、家属满意度[纽卡斯尔护理满意度量表(Newcastle Satisfaction with Nursing Scale,NSNS)]。采用t检验、χ^(2)检验。结果干预后目标管理组血清胆红素水平(157.49±15.82)μmol/L低于常规组(204.83±15.29)μmol/L(P<0.05)。目标管理组黄疸消退时间较常规组短[(6.36±1.27)d比(7.13±1.06)d],差异有统计学意义(t=3.191,P=0.002)。干预后目标管理组白天睡眠时间、夜间睡眠时间[(8.32±1.39)h、(8.55±1.29)h]均较常规组[(7.30±1.41)h、(7.62±1.34)h]长(均P<0.05)。目标管理组不适症状总发生率[8.51%(4/47)]与常规组[21.28%(10/47)]比较,差异无统计学意义(P>0.05)。目标管理组家属满意度[95.74%(45/47)]高于常规组[68.09%(32/47)](P<0.05)。结论将目标管理理论的护理模式应用于新生儿高胆红素血症患儿中,能降低血清胆红素水平、缩短黄疸消退时间、延长睡眠时间、提高家属满意度。

MAGiC技术诊断新生儿高胆红素血症

目的 观察MAGiC技术诊断新生儿高胆红素血症(NHB)的价值。方法 前瞻性纳入33例NHB新生儿作为NHB组,以30名正常新生儿为对照组;行MAGiC序列颅脑MR扫描,记录苍白球、壳核及丘脑ROI定量值,包括T1、T2弛豫值及质子密度(PD)值,并计算苍白球/壳核定量比值。比较组间各脑区定量值及定量比值,绘制受试者工作特征曲线,计算曲线下面积(AUC)以评估诊断效能,并以Pearson相关性分析评估血清总胆红素(TSB)水平与各脑区定量值及定量比值的相关性。结果 组间各脑区T1、T2及PD值差异均无统计学意义(P均>0.05);NHB组苍白球/壳核T1值比值、T2值比值均小于对照组(P均<0.05)。苍白球/壳核T1值比值诊断NHB的AUC为0.79(P<0.05);而苍白球/壳核T2值比值诊断NHB的效能低(AUC=0.63,P>0.05)。TSB与苍白球T2值(r=-0.299,P<0.05)、苍白球/壳核T1值比值(r=-0.480,P<0.05)及苍白球/壳核T2值比值(r=-0.328,P<0.05)均呈负相关。结论 以MAGiC技术获取苍白球/壳核T1值比值对于诊断NHB具有一定价值。

神经节苷脂对初生大鼠高胆红素血症脑组织AIF表达的调节作用

目的研究脑源性高糖苷类物质神经节苷脂(GM1)对初生大鼠在高胆红素血症时脑组织海马CA1区凋亡诱导因子(apoptosis-inducing factor,AIF)表达的影响。方法选取120只7日龄SD大鼠,将其随机分为对照组、模型组和GM1组。通过腹腔注射胆红素溶液100μg/g构建高胆模型;对照组腹腔注射等量0.9%NaCl;GM1组在高胆模型建立后立即给予腹腔注射1次GM1(10μg/g),随后在未处死前每天按相同方法及剂量腹腔注射1次GM1。分别于造模后6,24,48,72,96 h观察大鼠行为,随后各组每个时间点各取8只处死取脑组织。应用免疫组化和TUNEL染色测定不同时间点脑组织海马CA1区AIF蛋白表达及神经细胞凋亡。结果对照组在各时间节点未见明显AIF表达和凋亡细胞;模型组脑组织海马区在6 h出现AIF表达和凋亡细胞,并随时间延长AIF表达和凋亡细胞逐渐增多,于96 h达高峰。与模型组比较,GM1组各时间点AIF表达和细胞凋亡均明显减少(P<0.05),而且GM1组各时间点AIF表达和细胞凋亡仍高于对照组(P<0.05)。结论神经节苷脂(GM1)在初生大鼠高胆红素血症时可能通过抑制脑组织海马CA1区AIF表达及细胞凋亡发挥其脑保护作用。

新生儿高胆红素血症患儿住院费用的分位数回归分析

目的 通过统计新生儿高胆红素血症患儿住院费用及相关母婴信息、住院信息、诊疗信息,分析单病种费用的影响因素,以期为医保按病种分值付费(diagnosis-intervention packet,DIP)方式改革和医院单病种费用控制提供可参考的建议和方法。方法 通过病案信息系统,调取2018—2022年在鲁中地区某三甲妇幼保健院住院治疗的新生儿高胆红素血症患儿的住院费用及相关信息,采用单因素分析、分位数回归分析患儿住院费用的影响因素。结果 年份、医疗付款方式、并发症、患儿年龄、住院天数、胎次、入院经皮测胆值、喂养方式、大便情况、总胆红素水平对患儿住院费用的影响差异有统计学意义(P<0.05)。不同分位费用组中,各影响因素作用方向及趋势不同。结论 我国公立医院实行的耗材“零差价”政策及药品集中带量采购,有效地遏制了患儿住院费用的增长;关爱母婴健康,降低血清总胆红素水平,减少无效的住院天数,降低新生儿高胆红素血症患儿并发症发生率是合理控制费用增长的重要手段。