新生儿溶血症患者居家黄疸监测远程随访研究  

Remote monitoring of neonatal jaundice in newborns with ABO hemolytic disease

作　　者：徐春彩 包盈颖 朱佳骏[1] 滕燕萍[1] 何源远[1] 程柯 纪凤娟 吴明远[1] XU Chuncai;BAO Yingying;ZHU Jiajun;TENG Yanping;HE Yuanyuan;CHENG Ke;JI Fengjuan;WU Mingyuan(Department of Neonatology,Women's Hospital,Zhejiang University School of Medicine,Hangzhou 310006,China)

机构地区：[1]浙江大学医学院附属妇产科医院新生儿科,浙江杭州310006

出　　处：《浙江大学学报（医学版）》2020年第5期651-655,共5页Journal of Zhejiang University(Medical Sciences)

基　　金：国家卫生健康委科学研究基金;浙江省医药卫生重大科技计划(WKJ-ZJ-2032)。

摘　　要：目的:分析新生儿溶血症患者出院后采取居家黄疸监测方法进行远程随访的可行性。方法:2020年1月20日至2月29日浙江大学医学院附属妇产科医院新生儿科收治的胎龄35周及以上、血清学检查确诊新生儿溶血症且实现黄疸远程随访患者为观察组(46例),2018年同期采取门诊随访的新生儿溶血症患者作为对照组(56例)。观察组患儿出院后居家应用经皮黄疸仪监测黄疸情况,利用手机开展远程随访。分析两组患儿住院期间相关资料以及出院后随访资料(包括是否再次门诊检查、是否再入院、入院时血清总胆红素水平等)。结果:两组患儿出生胎龄、出生体质量、分娩方式、性别等一般情况差异均无统计学意义(均P>0.05)。两组患儿因高胆红素血症首次住院天数、首次血清总胆红素水平、出院时血清总胆红素水平、首次入院期间采取的治疗措施差异均无统计学意义(均P>0.05)。观察组和对照组门诊随访次数分别为(1.3±0.8)次和(3.8±0.5)次,差异有统计学意义(P<0.01)。观察组和对照组再入院率分别为17.4%(8/46)和12.5%(7/56),差异无统计学意义(P>0.05);再入院时平均体质量分别为(3398±452)g和(3477±324)g,差异无统计学意义(P>0.05);再入院时血清总胆红素水平分别为(265±16)μmol/L和(295±15)μmol/L,差异有统计学意义(P<0.01);患儿均未发生急性胆红素脑病。结论:疫情期间采用居家黄疸监测和远程随访方式可减少患儿及监护人的不必要外出,且不增加患儿再入院率和发生高胆红素血症的风险。Objective:To explore the feasibility of remote monitoring of neonatal jaundice in newborns with ABO hemolytic disease.Methods:Forty six neonates of gestational age>35 weeks with ABO hemolytic disease admitted to Women's Hospital,Zhejiang University School of Medicine from January 20th,2020 to February 29th,2020 were enrolled in the study(study group).The newborns were followed up at home after discharge,the transcutaneous bilirubin(TCB)levels were measured by parents using the provided device and the results were sent to the doctor by smart phone using the installed APP.Fifty six newborns with ABO hemolytic disease admitted in 2018 who received conventional outpatient follow-up after discharge served as the control group.The demographic characteristics,total serum bilirubin(TSB)level during hospitalization,number of outpatient visit and rate of re-admission due to rebound hyperbilirubinemia were compared between the two groups.Results:There were no significant differences between the two groups in gestational age,birth weight,delivery mode,gender,length of the first hospitalization,TSB level before phototherapy and before discharge,and the managements during the first hospitalization(all P>0.05).Compared with the control group,TSB level before readmission[(265±16)μmol/L vs.(295±15)μmol/L]and the number of outpatient visits(1.3±0.8 vs.3.8±0.5)were significantly lower in the study group(all P<0.01),while the rate of readmission(17.4%vs.12.5%)and the weight at the time of readmission[(3398±452)g vs.(3477±324)g]were not significantly different(all P>0.05).No cases of acute bilirubin encephalopathy occurred in both groups.Conclusion:The remote follow-up for neonatal jaundice at home can effectively reduce the number of outpatient visits without increasing the risk of readmission and severe neonatal hyperbilirubinemia for newborns with ABO hemolytic disease.

关 键 词：黄疸 新生儿 胆红素 监测 随访研究 远程医学 

分 类 号：R722.18[医药卫生—儿科]