Correlation between Transcutaneous Bilirubinemia and Blood Bilirubinemia in Screening Term Newborn for Neonatal Jaundice at the Essos Hospital Centre (EHC), Yaoundé, Cameroon

Background: Early and non-invasive diagnosis of neonatal hyperbilirubinemia remains critical in dark skinned babies of low resource settings. Objective: To assess correlation/agreement between transcutaneous bilirubin (Tcb) and serum bilirubin (Tsb) values in full term neonates with jaundice. Methodology: An analytical cross-sectional study was conducted at the neonatology unit of the Essos Hospital Centre (EHC) from January to June 2019. All full-term neonates aged 0 to 7 days with suspected jaundice who did not receive phototherapy were eligible for the study. The enrolled neonates in the study were assessed clinically, then with the MBJ20 transcutaneous bilirubinometer (TcB). The MBJ20 transcutaneous bilirubinometer highest measurement over the forehead and the sternum were compared to TsB. Data were entered and then analysed with the CsPro7.2 and R (version 3.6.0) software. Correlation was captured by Bland & Alman plots and Concordance Correlation Coefficient (CCC) estimates. The Pearson correlation coefficient and Student test for paired data were used for descriptions purposes, and the significance level was 5%. Results: We recruited 88 neonates. The sex ratio of the babies included was 1.25 favouring males. Median Post-natal age was 3 days with 62% aged 72 hours or more. The mean TcB corresponding to the maximum average between frontal and sternal measurement was 153 mg/dl ± 48 and the average Tsb was 123.80 mg/dl ± 50.48. A good linear correlation was found between TcB and total serum bilirubin level r = 0.86 [0.80;0.91]. Positive correlation was noted between both (forehead and sternum) TcB measurements sites, namely r = 0.78 and r = 0.86. The Bland & Altman plot measured the bias at -29.68 mg/l (confidence interval at 95%, 21.14 - 80.50). The CCC estimate was 0.2 varying from -0.22 to 0.76 according to TcB measurement threshold and post-natal age. The ROC area under the curve value for a threshold < 100 mg/l equals 90% proving to be a good predictor for this threshold. Conclusion: A good linear correlation was found despite a poor agreement between TcB and Tsb. TcB method systematically overestimated the value of TsB.

Facility-based constraints to exchange transfusions for neonatal hyperbilirubinemia in resource-limited settings

Several clinical guidelines for the management of infants with severe neonatal hyperbilirubinemia recommend immediate exchange transfusion(ET) when the risk or presence of acute bilirubin encephalopathy is established in order to prevent chronic bilirubin encephalopathy or kernicterus. However, the literature is sparse concerning the interval between the time the decision for ET is made and the actual initiation of ET, especially in low- and middle-income countries(LMICs) with significant resource constraints but high rates of ET. This paper explores the various stages and potential delays during this interval in complying with the requirement for immediate ET for the affected infants, based on the available evidence from LMICs. The vital role of intensive phototherapy, efficient laboratory and logistical support, and clinical expertise for ET are highlighted. The challenges in securing informed parental consent, especially on religious grounds, and meeting the financial burden of this emergency procedure to facilitate timely ET are examined. Secondary delays arising from posttreatment bilirubin rebound with intensive phototherapy or ET are also discussed. These potential delays can compromise the effectiveness of ET and should provide additional impetus to curtail avoidable ET in LMICs.

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.

Effects of Yinzhihuang oral liquid and albumin on bilirubin, inflammatory factors, immune indexes and related factors in neonatal pathologic jaundice

Objective: To explore the effects of Yinzhihuang oral liquid and albumin on bilirubin, inflammatory factors, immune indexes and related factors in neonatal pathologic jaundice. Methods: A total of 134 neonates with pathologic jaundice admitted to our hospital from May 2017 to April 2018 were randomly selected as the control group (n=67) and the observation group (n=67), the control group was treated with albumin, the observation group was treated with Yinzhihuang Oral Liquid on the basis of the control group. The bilirubin, inflammatory factors, immune indicators, alpha-fetoprotein (AFP) and transferrin (TRF) were compared and analyzed before and after treatment. Results: After treatment, the levels of TBIL, DBIL and IBIL in both groups were significantly lower than those before treatment (P<0.05), and the levels of TBIL, DBIL and IBIL [(118.60±10.85) μmol/L, (6.95±1.52) μmol/L, (115.30±14.20)μmol/L] in observation group were significantly lower than those in control group;the levels of CRP and IL-6 in both groups were significantly lower than those before treatment (P<0.05), and the levels of CRP and IL-6 [(8.26±2.07) mg/L, (12.69±2.15) pg/mL] in observation group were significantly lower than those in control group (P<0.05);the levels of CD4+, CD4+/CD8+ in both groups were significantly higher than those before treatment (P<0.05), while the levels of CD8+ was significantly lower than that before treatment, the levels of CD4+, CD4+/CD8+ [(47.08±5.70)%, (2.08±0.41)] in observation group were significantly higher than those in control group (P<0.05), and the level of CD8+ [(22.90±2.05)%] was significantly lower than that in control group (P<0.05);the levels of AFP in significantly higher than before treatment (P<0.05), and the levels of AFP [(12.69±3.04)mg/L] in observation group were significantly lower than those in control group (P<0.05), the levels of TRF [(2.02±0.35) g/L] were significantly higher than those in control group (P<0.05). Conclusions: The combination of Yinzhihuang oral liquid and albumin can effectively reduce the bilirubin level in neonatal jaundice, inhibit its inflammatory reaction, enhance the cellular immune function and improve the expression of AFP and TRF, which is of clinical significance.

Assessment of adjuvant ademetionine therapy for the bilirubin metabolism and target organ function of neonatal jaundice

Objective: To study the effect of adjuvant ademetionine (SAMe) therapy on the bilirubin metabolism and target organ function of neonatal jaundice. Methods: A total of 68 children who were diagnosed with neonatal jaundice in Hubei Jianghan Oilfield General Hospital between March 2015 and April 2017 were selected as the research subjects and randomly divided into the SAMe group who received ademetionine combined with blue ray irradiation and the control group who received blue ray irradiation. The serum contents of bilirubin metabolism indexes and target organ injury markers before treatment as well as 3 d and 7 d after treatment. Results: 3 d and 7 d after treatment, serum TBIL, ALT, AST, GGT, TBA, CK-MB, cTnT, MYO, HBDH, NSE, S100B and GFAP levels of both groups were lower than those before treatment, and serum TBIL, ALT, AST, GGT, TBA, CK-MB, cTnT, MYO, HBDH, NSE, S100B and GFAP levels of SAMe group were lower than those of control group. Conclusion: Adjuvant ademetionine therapy can improve the bilirubin metabolism of neonatal jaundice and reduce the central nerve, myocardial and liver injury.

Measurement of Transcutaneous Bilirubin with Bilicheck as a Jaundice Screening Method in Neonates in Pediatric Emergency Departments

Objectives: To study the reliability of a transcutaneous bilirubinometer (Bilicheck) to determine bilirubin levels in neonates consulting for jaundice in a Paediatric Emergency Department (ED), and to evaluate its usefulness as a screening method. Methods: Prospective observational study realized between June of 2005 and December of2005 inneonates consulting at a paediatric emergency department for jaundice, in whom we realized both transcutaneous and total serum bilirubin measurements (TcB and TSB). We collected demographic variables, analytical variables (serum and transcutaneous bilirubin levels), length of stay in the ED, and need for treatment. Results: 66 children were included aged 2 to 31 days (81% of the sample were 2 to 7 days old). There was a close and statistically significant correlation between TcB and TSB (r = 0.81, p < 0.001). The area under the ROC curve was of 0.90, allowing detecting newborns with jaundice susceptible of treatment with TcB levels ≥ 13 mg/dL (sensitivity 92%, specificity 63, 5%, a positive predictive value 39% and a negative predictive value 97%). The number of venous punctures could be reduced in 50%. The medium stay in the ED was of 2 hours when performing serum measurements. Conclusions: A linear correlation exists between TcB-TSB. TcB measurement cannot replace that of TsB, however it could be used as a screening method in an ED to determine which neonates need confirmation by TsB measurement. The use of transcutaneous bilirubinometer would reduce both the number of painful interventions in neonates and the medium length of stay in ED, consequently reducing iatrogenesis.

Clinical Study on the Treatment of Neonatal Jaundice with Lidan Tuihuang Formula Combined with Bifid Lriple Viable and Blue Ray Irradiation

OBJECTIVE: To observe the clinical efficacy of Lidan Tuihuang formula combined with Peifeikang and blue light irradiation in the treatment of neonatal jaundice. METHODS: a total of 140 cases of neonatal jaundice were randomly divided into the observation group and the control group, with 70 cases in each group. The control group was treated with blue light irradiation and oral Bifid Lriple Viable, on the basis of conventional clinical interventions. The observation group was treated with Lidan Tuihuang formula on the basis of the control group. After 7 days of treatment, the scores of clinical symptom(skin yellowness, reduced milk volume, constipation, abdominal distension) and level of serum bilirubin before and after treatment were compared between the two groups, and the adverse reactions and clinical recurrence of the 2 groups were statistically analyzed. RESULTS: After treatment, the effective rate was 94.3% in the observation group which was significantly higher than that in the control group(77.1%)(P < 0.05). The degree of yellowing of the skin, the reduction of the amount of milk, the concentration of constipation and the distension of bloating were all significantly reduced in the 2 groups after treatment(P < 0.05), and the improvement of the above indexes in the observation group was significantly better than that in the control group(P < 0.05). The level of serum bilirubin was significantly lower in the 2 groups after treatment and even for 2 weeks after treatment(P < 0.05). The improvement level of serum bilirubin in the observation group after treatment and even for 2 weeks after treatment were significantly better than that in the control group(P < 0.05). The recurrence rate in the observation group was 8.7%, which was significantly lower than that in the control group 22.2 %(P < 0.05); No serious adverse reactions occurred in both groups. CONCLUSION: The combination of Lidan Tuihuang Formular, Bifid Lriple Viable, blue light irradiation for neonatal jaundice can rapidly improve the clinical symptoms of children, reduce the level of serum bilirubin and shorten the treatment time, with no obvious adverse reactions and high clinical safety.

Characteristics and outcome of newborn admitted with acute bilirubin encephalopathy to a tertiary neonatal intensive care unit

Background Acute bilirubin encephalopathy (ABE) still represents a significant cause of morbidity and mortality throughout the world,especially in developing countries.We aimed to determine the prevalence of ABE based on the Johnson bilirubininduced neurologic dysfunction (BIND) score and to describe the discharge outcomes.Methods We prospectively studied all newborns ≥ 35 weeks with ABE by evaluating signs of mental sensorium,muscle tone,and cry patterns over 1 year.Results 12% (81 out of 674) of the newborns admitted for neonatal hyperbilirubinemia had a BIND score > 1.Their admission age was 6 ± 4.1 days;total serum bilirubin (TSB) was 31.2± 10 mg/dL (range 17.5-75.2).Of these newborns,40.7% and 21% had evidence of haemolysis and sepsis,respectively.Overall mortality was 9.9%;58% of the newborns showed signs of mild-to-moderate BIND at discharge,while 32.1% survived with an apparently normal outcome.Admission BIND score was significantly correlated with admission TSB (r=0.476,P < 0.001).Similarly,BIND score at discharge was correlated with admission TSB (r=0.442,P < 0.001) and admission BIND score (r =0.888,P < 0.001).The regression model showed that admission TSB (P < 0.001) and maternal illiteracy (P =0.034) were predictors of the BIND score at admission,while admission BIND score was the best indicator of the discharge score (P < 0.001).Conclusions ABE is still a major problem in our community.Admission TSB and maternal illiteracy are good predictors of bilirubin encephalopathy at admission and discharge.

Effect of metoclopramide administration to mothers on neonatal bilirubin and maternal prolactin: a randomized, controlled, clinical trial

Background Jaundice is a common neonatal problem.This study was conducted to determine the effect of metoclopramide on neonatal bilirubin and maternal prolactin (primary outcomes) and milk volume (secondary outcome).Methods This triple-blind,randomized,controlled,clinical trial was conducted on 112 mothers.The participants were assigned to the intervention (metoclopramide) and control groups (placebo) using block randomization.Ten-mg metoclo-pramide and placebo tablets were taken by the participants three times a day.The intervention began in the first 2-10 hours after childbirth and continued until the fifth day.The mothers' prolactin level was measured on the first morning after the intervention and on the sixth day (1 day after the intervention was over).Neonatal total bilirubin was also measured before the intervention and on the sixth day.Results After the intervention,the two groups did not differ significantly in terms of the mean neonatal indirect bilirubin (P =0.565) and milk volume (P =0.261),but the mean serum prolactin was significantly higher in the metoclopramide group compared to the placebo group (adjusted mean difference 37;95% confidence interval 58.1-16.5;P =0.001).Conclusions Metoclopramide increased maternal serum prolactin but had no effects on neonatal jaundice.The insufficient numbers of studies on this subject mandate further research.

Bilirubin nomograms for identifi cation of neonatal hyperbilirubinemia in healthy term and late-preterm infants:a systematic review and meta-analysis

Background:Hyperbilirubinemia occurs in most healthy term and late-preterm infants,and must be monitored to identify those who might develop severe hyperbilirubinemia.Total serum bilirubin(TSB)or transcutaneous bilirubin(TcB)nomograms have been developed and validated to identify neonatal hyperbilirubinemia.This study aimed to review previously published studies and compare the TcB nomograms with the TSB nomogram,and to determine if the former has the same predictive value for signifi cant hyperbilirubinemia as TSB nomogram does.Methods:A predefined search strategy and inclusion criteria were set up.We selected studies assessing the predictive ability of TSB/TcB nomograms to identify significant hyperbilirubinemia in healthy term and late-preterm infants.Two independent reviewers assessed the quality and extracted the data from the included studies.Meta-Disc 1.4 analysis software was used to calculate the pooled sensitivity,specificity,and positive likelihood ratio of TcB/TSB nomograms.A pooled summary of the receiver operating characteristic of the TcB/TSB nomograms was created.Results:After screening 187 publications from electronic database searches and reference lists of eligible articles,we included 14 studies in the systematic review and meta-analysis.Eleven studies were of medium methodological quality.The remaining three studies were of low methodological quality.Seven studies evaluated the TcB nomograms,and seven studies assessed TSB nomograms.There were no differences between the predictive abilities of the TSB and TcB nomograms(the pooled area under curve was 0.819 vs.0.817).Conclusions:This study showed that TcB nomograms had the same predictive value as TSB nomograms,both of which could be used to identify subsequent signifi cant hyperbilirubinemia.But this result should be interpreted cautiously because some methodological limitations of these included studies were identifi ed in this review.

Sixth hour transcutaneous bilirubin predicting significant hyperbilirubinemia in ABO incompatible neonates

Background:Neonates with ABO hemolytic disease are at greater risk for developing significant hyperbilirubinemia.We aimed to determine whether sixth hour transcutaneous bilirubin(TcB)could predict such a risk.Methods:TcB measurements were obtained at the 6th hour of life in blood group A or B neonates born to blood group O,rhesus factor compatible mothers.Subsequent hyperbilirubinemia was monitored and considered significant if a neonate required phototherapy/exchange transfusion.The predictive role of sixth hour TcB was estimated.Results:Of 144 ABO incompatible neonates,41(OA,24;O-B,17)had significant hyperbilirubinemia.Mean sixth hour TcB was significantly higher among neonates who developed significant hyperbilirubinemia than those who did not(5.83±1.35 mg/dL vs.3.65±0.96 mg/dL,P<0.001).Sixth hour TcB value>4 mg/dL had the highest sensitivity of 93.5%and>6 mg/dL had the highest specifi city of 99%.Area under receiver operating characteristic curve was 0.898.Conclusion:Sixth hour TcB predicts subsequent significant hyperbilirubinemia in ABO incompatible neonates.

新生儿外周血检出胆红素结晶1例报道

胆红素结晶临床可见于阻塞性黄疸、急性肝坏死等疾病个体,出现在胸腹水、关节液中有报道,而外周血检出胆红素结晶罕见。本文报道1例出生4 d男性患儿,诊断为新生儿呼吸窘迫综合征、高胆红素血症。外周血涂片镜检于部分中性粒细胞、单核细胞内见金黄色、折光性强,呈针状、菱形、矩形、斜方体形或长方体形胆红素结晶。根据临床经验,显著高胆红素血症的新生儿外周血偶见胆红素结晶,可造成血清胆红素测定结果偏低。提示血常规结果的审核,需在审核各项检测数值的同时,务必注意观察散点图和报警信息,并结合血清胆红素水平及临床表现,镜检时仔细观察细胞形态,以便及时发现仅仅依靠检测数值发现不了的对临床诊疗有意义的形态学异常结果。

高产胆盐水解酶乳杆菌的筛选及对新生大鼠黄疸的防治作用

为筛选高产胆盐水解酶的乳杆菌,探究其对新生儿黄疸的防治作用。采用添加了25 U/mL制霉菌素的LBS选择性培养基,从健康新生儿粪便和母乳中筛选乳杆菌并鉴定种类;以鼠李糖乳杆菌LGG为阳性对照,体外评估菌株的益生菌特性;利用盐酸苯肼诱导新生SD大鼠黄疸模型,通过分析血清胆红素水平和肝脏组织的损伤情况,以及肝脏炎症因子、核转录因子的相对表达水平,探究高产胆盐水解酶乳杆菌对新生大鼠黄疸的防治作用及机制。结果表明,来自婴儿粪便的格氏乳杆菌FWJL-5在体外具良好的益生特性,并且产胆盐水解酶能力优于LGG,能够显著缓解新生大鼠胆红素水平升高、肝脏组织肿胀和溶血症状,减少肝脏损伤中肝酶的释放,抑制促炎因子的分泌,促进UGt1A1和上游核转录因子孕烷X受体(pregnane X receptor,pXR)、法尼醇X受体(farnesol X receptor,FXR)的表达。综上所述,婴儿粪便来源的格氏乳杆菌FWJL-5可通过上调核受体FXR/pXR促进UGt1A1表达以调节肝脏胆红素代谢,从而减轻新生大鼠黄疸症状,本研究可为格氏乳杆菌防治新生儿黄疸提供新思路。

胆红素总量/白蛋白比值、听力筛查及MRI-T_(1)WI影像对新生儿急性胆红素脑病的诊断价值

目的:探究胆红素总量/白蛋白比值(B/A)、听力筛查及磁共振成像-T_(1)加权成像(MRI-T_(1)WI)对新生儿急性胆红素脑病(ABE)的诊断价值。方法:选取2013年6月—2023年6月于太仓市第一人民医院接受治疗的136例新生儿高胆红素血症(NHB)患儿作为研究对象,根据是否并发ABE分为并发组(n=42)和对照组(n=94)。对比两组的临床资料、B/A水平、听力筛查结果、苍白球T_(1)WI信号强度,对单因素分析有意义的指标进行多因素logistic回归分析,采用ROC曲线分析其对新生儿ABE的诊断价值。结果:并发组总血清胆红素(TSB)峰值、B/A水平均高于对照组,差异有统计学意义(P<0.05)。并发组初筛听力异常率为38.10%,复筛听力异常率为35.71%,均高于对照组的18.09%、8.51%,差异有统计学意义(P<0.05)。并发组苍白球与额叶脑皮质T_(1)WI信号强度比值(G/Gr)水平高于对照组,差异有统计学意义(P<0.05)。logistic回归分析显示,B/A、听力异常和G/Gr水平表达均为影响NHB患儿并发ABE的独立危险因素,差异有统计学意义(P<0.05)。ROC曲线分析显示,B/A、G/Gr、听力异常及三者联合检测NHB患儿并发ABE的AUC值分别为0.773、0.652、0.754、0.863,有较高诊断价值,且联合诊断价值最高(P<0.05)。结论:ABE患儿中B/A、听力异常和G/Gr表达水平明显升高,三者单独和联合检测NHB患儿并发ABE均有较高诊断价值,其中三者联合诊断效果最佳。

新生儿急性胆红素脑病相关危险因素的meta分析

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。

新生儿病理性黄疸血清总胆红素、AST、ALT、ALB水平与蓝光治疗效果的关系

目的 研究新生儿病理性黄疸血清总胆红素、谷草转氨酶(AST)、谷丙转氨酶(ALT)、白蛋白(ALB)水平与蓝光治疗效果的关系。方法 收集2020年6月至2022年12月期间于南阳市中心医院新生儿重症监护病区诊治的97例新生儿病理性黄疸的病历资料,根据患儿蓝光照射治疗效果评估结果分为有效组和无效组,其中有效组共57例,无效组共40例。两组患儿均接受蓝光照射治疗,并进行血清总胆红素、AST、ALT、ALB检测。比较两组治疗前黄疸指数、血清总胆红素、AST、ALT、ALB水平,并分析患儿治疗前血清总胆红素、AST、ALT、ALB水平与蓝光治疗效果相关性。结果 治疗前,有效组黄疸指数低于无效组,差异有统计学意义(t=3.346,P<0.05);有效组血清总胆红素、AST、ALT水平低于无效组,血清ALB水平高于无效组,差异有统计学意义(t=3.635、2.273、2.167、8.689,P<0.05);经Logistic多因素分析,总胆红素、AST、ALT水平变化均为影响新生儿病理性黄疸病情严重程度的独立危险因素,ALB水平变化为影响新生儿病理性黄疸病情严重程度的独立保护因素(P<0.05);经Spearman相关性分析显示,患儿治疗前血清总胆红素、AST、ALT与病情严重程度成正比,ALB水平与病情严重程度成反比(P<0.05)。结论 治疗前新生儿病理性黄疸血清总胆红素、AST、ALT水平越低,ALB越高,可提示患儿病情程度越轻,从而越有利于蓝光治疗效果。

网织红细胞及血清TBiL联合溶血三项在新生儿溶血病中的临床诊断分析

目的探讨网织红细胞及血清总胆红素(TBi L)联合溶血三项在新生儿溶血病中的临床诊断价值。方法对安阳市中医院2019年10月至2022年10月收治的140例疑似新生儿溶血病的新生儿患者的临床资料进行回顾性分析,以临床确诊为标准,将所有患儿分为非新生儿溶血病组(40例)和新生儿溶血病组(100例)。检测两组患儿溶血三项、网织红细胞及血清TBi L。分析溶血三项的检测结果,对比溶血三项检查与临床确诊新生儿溶血病的结果,将新生儿溶血病组和非新生儿溶血病组患儿网织红细胞、血清TBi L水平进行对比,分析溶血三项、网织红细胞、血清TBi L,以及上述指标联合检测诊断新生儿溶血病的临床价值。结果140例疑似新生儿溶血病的新生儿患者中确诊患儿100例,非疾病患儿40例,溶血三项检测结果诊断出新生儿溶血病患儿102例,阳性检出率为72.86%,非新生儿溶血病患儿38例(27.14%),新生儿溶血病组患儿网织红细胞(6.99±1.40)%、TBi L(237.21±77.11)μmol/L均比非新生儿溶血病组高(3.47±0.95)%、(170.05±48.65)μmol/L(均P<0.05);溶血三项诊断新生儿溶血病的灵敏度为89.00%(89/100),特异度为67.50%(27/40),阳性预测值和阴性预测值分别为87.25%(89/102)、71.05%(27/38);以5.11%、198.75μmol/L为网织红细胞、TBi L诊断新生儿溶血病的最佳截断值,溶血三项、网织红细胞、血清TBi L及联合检测诊断新生儿溶血病的灵敏度、特异度分别为95.70%、87.56%,均比单项检测的数值高。结论新生儿溶血病患儿网织红细胞、TBi L均比非新生儿溶血病组高,且溶血三项、网织红细胞及血清TBi L联合检测应用于对新生儿溶血病的诊断中,临床应用价值较高。

新生儿呼吸窘迫综合征无创经皮血气+体位管理+保护性通气前后MMP-16、Claudin-18、CC16变化及与并发支气管肺发育不良的相关性

目的探讨无创经皮血气+体位管理+保护性通气干预新生儿呼吸窘迫综合征对患儿基质金属蛋白酶16(matrix metalloproteinase 16,MMP-16)、紧密连接蛋白18(Claudin 18 protein,Claudin-18)和Clara细胞分泌蛋白16(Clara cell secretes protein 16,CC16)的影响,并分析上述指标与支气管肺发育不良(bronchopulmonary dysplasia,BPD)的相关性。方法前瞻性选取呼吸窘迫综合征新生儿106例为研究对象,所有患儿均接受无创经皮血气+体位管理+保护性通气干预,观察患儿干预前后MMP-16、Claudin-18、CC16变化。统计患儿2周内BPD发生状况,并将其分为BPD组与非BPD组,分析MMP-16、Claudin-18、CC16与BPD发生的关系。结果干预后,MMP-16水平低于干预前,Claudin-18、CC16水平高于干预前(P<0.05);106例呼吸窘迫综合征患儿中发生BPD 57例,占53.77%;与非BPD组相比,BPD组MMP-16水平更高,Claudin-18、CC16水平更低(P<0.05);经点二列相关性分析,结果显示,MMP-16与BPD发生呈正相关(r=0.542,P<0.05),Claudin-18、CC16水平与BPD发生呈负相关(r=-0.526,-0.639,P<0.05);经Logistic回归分析,结果显示,MMP-16是呼吸窘迫综合征患儿并发BPD的危险因素(OR>1,P<0.05),Claudin-18、CC16是保护因素(OR<1,P<0.05);绘制受试者工作曲线(receiver operating characteristic curve,ROC)曲线,结果显示,MMP-16、Claudin-18、CC16评估呼吸窘迫综合征患儿并发BPD的AUC均>0.7,具有一定评估价值,联合评估价值更高(AUC=0.902)。结论无创经皮血气+体位管理+保护性通气可改善降低急性呼吸窘迫综合征患儿MMP-16水平,升高Claudin-18、CC16水平,上述3项指标变化与BPD的发生密切相关。

新生儿抚触联合中医穴位按摩护理在新生儿黄疸中的应用研究

目的 探究在新生儿黄疸中应用新生儿抚触联合中医穴位按摩护理的效果。方法 以2021年5月—2023年5月为研究开展时段,抽选在该时段内在商丘市第一人民医院分娩出生确诊黄疸的新生儿80例为研究对象,按照电脑随机分组的方式划分40例为对照组,接受常规新生儿抚触护理,余40例患儿为观察组,在对照组的基础上增加中医穴位按摩,比较两组患儿的护理前后经皮胆红素值(TCB)、血清胆红素水平(TB)、血清直接胆红素水平(DB)值、黄疸消退时间、胆红素恢复时间、日睡眠时间、日排便次数、体质量增长。结果 护理后,观察组观察组TCB下降快于对照组(P<0.05);TB、DB均低于对照组(P<0.05);黄疸消失时间、血清胆红素恢复时间均短于对照组(P<0.05);日睡眠时间、日排便次数、体质量均高于对照组(P<0.05)。结论 在新生儿黄疸中应用新生儿抚触联合中医穴位按摩护理的效果较好,可降低血清胆红素水平,改善黄疸症状,加快黄疸消退,保障了新生儿睡眠时间,利于新生儿排便和正常哺育,体质量向正向情况良好发展。

双歧杆菌口服联合静脉注射丙种球蛋白蓝光照射治疗新生儿ABO溶血性黄疸的疗效观察

目的探究双歧杆菌口服联合静脉注射丙种球蛋白(IVIG)、蓝光照射治疗新生儿ABO溶血性黄疸的效果。方法选取温州市中心医院新生儿科2020年1月至2023年1月103例ABO溶血性黄疸新生儿,根据治疗方法分为对照组(51例,IVIG联合蓝光照射治疗)和观察组(52例,双歧杆菌口服联合IVIG、蓝光照射治疗)。对比2组临床疗效,经皮胆红素值、心肌酶谱和肝功能指标及不良反应。结果观察组黄疸消除时间、首次排便时间和胎便转黄时间短于对照组(P<0.05);治疗3、5、7 d后,经皮胆红素值降低,观察组低于对照组(P<0.05);治疗后心肌酶谱指标活性降低,且观察组的血清肌酸激酶同工酶(CK-MB)、肌酸激酶(CK)、乳酸脱氢酶(LDH)活性及天冬氨酸转氨酶(AST)含量低于对照组(P<0.05);2组不良反应发生率相近(P>0.05)。结论双歧杆菌口服联合IVIG、蓝光照射治疗新生儿ABO溶血性黄疸可以提高临床治疗效果,有效缩短黄疸消除时间,降低患儿经皮胆红素水平及促进心肌和肝脏组织恢复,且安全可靠,具有推荐价值。