江苏省13家医院新生儿严重高胆红素血症现状调查  

An investigation of severe neonatal hyperbilirubinemia in 13 hospitals of Jiangsu Province,China

作　　者：李倩倩 董小玥[2] 乔瑜 殷玉洁 高艳[5] 周金君[6] 杨丽[7] 朱荣平 王伏东 万俊[10] 徐艳 潘兆军[12] 王威远 闫俊梅[1] 韩树萍[2] 卢红艳[3] 胡毓华 李双双[6] 王金秀 吴明赴[9] 王军 邓晓毅[1] 余章斌[2] LI Qian-Qian;DONG Xiao-Yue;QIAO Yu;YIN Yu-Jie;GAO Yan;ZHOU Jin-Jun;YANG Li;ZHU Rong-Ping;WANG Fu-Dong;WAN Jun;XU Yan;PAN Zhao-Jun;WANG Wei-Yuan;YAN Jun-Mei;HAN Shu-Ping;LU Hong-Yan;HU Yu-Hua;LI Shuang-Shuang;WANG Jin-Xiu;WU Ming-Fu;WANG Jun;DENG Xiao-Yi;YU Zhang-Bin(Department of Pediatrics,Maternity Hospital,Nanjing Medical University,Nanjing 210004,China)

机构地区：[1]徐州市妇幼保健院新生儿科,江苏徐州221009 [2]南京医科大学附属妇产医院儿科,江苏南京211)004 [3]江苏大学附属医院儿科,江苏慎江212001 [4]江苏省妇幼保健院新生儿科,江苏南京210036 [5]连云港市妇幼保健院新生儿科,江苏连云港222000 [6]南通市妇幼保健院新生儿科,江苏南通226001 [7]泰州市人民医院新生儿科,江苏泰州225300 [8]常州市妇幼保健院新生儿科,江苏常州213003 [9]扬州大学附属医院新生儿科,江苏扬州225001 [10]江阴市人民医院新生儿科,江苏无锡214400 [11]徐州医科大学附属医院新生儿科,江苏徐州221002 [12]淮安市妇幼保健院新生儿科,江苏淮安223002 [13]宿迁市妇产医院新生儿科,江苏宿迁223800

出　　处：《中国当代儿科杂志》2020年第7期690-695,共6页Chinese Journal of Contemporary Pediatrics

基　　金：江苏省“六个一工程”拔尖人才科研项目(LGY2017004);江苏省妇幼健康重点人才(FRC201733);江苏省重点研发计划(社会发展)(BE2019620)。

摘　　要：目的了解江苏省新生儿严重高胆红素血症的发生情况及诊治、随访等管理情况,为新生儿严重高胆红素血症的预防及规范化管理提供依据。方法以2018年1~12月江苏省13家医院收治的严重高胆红素血症新生儿为研究对象,回顾性分析患儿的临床资料及随访资料。结果江苏省13家医院2018年严重高胆红素血症新生儿病例共上报740例,占新生儿科收治病例总数的2.70%(740/27?386),其中重度高胆红素血症620例(83.8%),极重度高胆红素血症106例(14.3%),危险性高胆红血症14例(1.9%);诊断为急性胆红素脑病共4例(0.5%)。484例(65.4%)新生儿于分娩机构出院后因严重高胆红素血症返回医院住院治疗,中位入院日龄为7 d,其中214例(44.2%)再入院前进行过门诊黄疸随访,第1次门诊中位随访日龄为6 d。住院期间行头颅MRI检查211例(28.5%),其中85例(40.3%)提示双侧基底节、苍白球T1WI信号偏高;行脑干听觉诱发电位检查238例(32.2%),其中14例(5.9%)仅一侧通过,7例(2.9%)双侧均未通过。急性胆红素脑病或危险性高胆红素血症患儿(共17例)进行了随访,除1例失访外,均无异常神经系统症状。结论新生儿严重高胆红素血症在新生儿科住院病人中的占比较高;新生儿从分娩机构出院后黄疸监测及管理需要加强;对并发了严重高胆红素血症的患儿,住院期间相关检查需更完善,出院后均需全面系统地随访。Objective To investigate the incidence of severe neonatal hyperbilirubinemia and the management on the treatment and follow-up of this disease in Jiangsu Province,China.Methods The neonates with severe hyperbilirubinemia who were admitted to 13 hospitals in Jiangsu Province from January to December,2018,were enrolled as subjects.A retrospective analysis was performed on their mediacal data and follow-up data.Results In 2018,740 neonates with severe hyperbilirubinemia were reported from the 13 hospitals in Jiangsu Province,accounting for 2.70%(740/27?386)of the total number of neonates admitted to the department of neonatology.Among these neonates,620(83.8%)had severe hyperbilirubinemia,106(14.3%)had extremely severe hyperbilirubinemia,and 14(1.9%)had hazardous hyperbilirubinemia.Four neonates(0.5%)were diagnosed with acute bilirubin encephalopathy.A total of 484 neonates(65.4%)were readmitted due to severe hyperbilirubinemia after discharge from the delivery institution,with a median age of 7 days,among whom 214(44.2%)were followed up for jaundice at the outpatient service before readmission,with a median age of 6 days at the first time of outpatient examination.During hospitalization,211 neonates(28.5%)underwent cranial MRI examinations,among whom 85(40.3%)had high T1WI signal in the bilateral basal ganglia and the globus pallidus;238 neonates(32.2%)underwent brainstem auditory evoked potential examinations,among whom 14(5.9%)passed only at one side and 7(2.9%)failed at both sides.The 17 neonates with acute bilirubin encephalopathy or hazardous hyperbilirubinemia were followed up.Except one neonate was lost to follow-up,and there were no abnormal neurological symptoms in the other neonates.Conclusions Neonates with severe hyperbilirubinemia account for a relatively high proportion of the total number of neonates in the department of neonatology.Jaundice monitoring and management after discharge from delivery institutions need to be strengthened.For neonates with severe hyperbilirubinemia,relevant examinations sh

关 键 词：高胆红素血症 急性胆红素脑病 多中心调查 新生儿 

分 类 号：R722.17[医药卫生—儿科]