茹颖;王长燕;王薇;李正红;
RU Ying;WANG Chang-yan;WANG Wei;LI Zheng-hong;Department of Pediatrics,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences &Peking Union Medical College;

• 1:中国医学科学院 北京协和医学院 北京协和医院儿科

摘要(Abstract)：

目的研究新生儿高胆红素血症再入院的相关危险因素。方法回顾性纳入2000年1月至2014年5月在北京协和医院儿科因高胆红素血症而两次入院的足月患儿44例(研究组),并随机抽取在此期间因高胆红素血症入院一次的足月患儿100例(对照组),比较两组病例在出生体重、胎龄、喂养方式、住院天数、蓝光照射及胆红素下降情况、血糖因素、感染因素、溶血因素、血管外出血因素等方面的差异,对新生儿高胆红素血症再入院情况及相关因素进行分析。结果研究组患儿胎龄明显小于对照组[(37.9±1.9)周比(38.9±1.1)周,P<0.01],但性别、出生体重差异无统计学意义(P>0.05)。研究组患儿诊断为高胆红素血症的平均时龄明显小于对照组[(64.1±32.0)h比(98.1±93.1)h,P=0.022];首次入院时胆红素值及出院时胆红素值均显著高于对照组[(266.8±73.5)μmol/L比(218.9±102.6)μmol/L,P=0.002;(193.2±23.9)μmol/L比(179.6±25.7)μmol/L,P=0.004];蓝光照射周期及时间明显长于对照组[(2.2±1.1)轮比(1.4±0.6)轮,P<0.001;(43.1±26.1)h比(29.1±13.1)h,P=0.002];平均住院天数及胆红素降至正常所用时间亦明显长于对照组[(4.1±3.0)d比(2.5±1.2)d,P=0.002;(43.1±25.5)h比(33.1±14.4)h,P=0.021]。此外,研究组的低血糖发生率显著高于对照组(16%比10%,P=0.019),但在感染、溶血及血管外出血方面两组间差异没有统计学意义(P>0.05)。结论胎龄越小、黄疸出现越早、胆红素水平越高、蓝光照射时间越长的患儿以及曾发生低血糖的患儿容易再次出现黄疸,对于符合上述情况的患儿建议考虑在胆红素降至正常后观察1 d再出院,以防止再入院的发生。
Objective To investigate the risk factors associated with readmission for neonatal hyperbilirubinemia. Methods We retrospectively analyzed the data of 44 infants( study group) who were admitted twice for hyperbilirubinemia to Department of Pediatrics of Peking Union Medical College Hospital in the period from January 2000 to May 2014. Meanwhile,100 infants admitted once for hyperbilirubinemia during the same period were randomly selected as control group. The two groups were compared in terms of birth weight,gestational age,feeding patterns,length of stay,time of phototherapy,level of bilirubin,blood glucose level,infection,hemolysis,and extravascular hemorrhage. The risk factors associated with readmission of neonates for hyperbilirubinemia were analyzed. Results The gestational age of the study group was significantly lower than those of the control group [( 37. 9 ± 1. 9) weeks vs.( 38. 9 ± 1. 1) weeks,P < 0. 01 ],but there was no difference ingender or birth weight( both P > 0. 05). The study group were diagnosed with hyperbilirubinemia significantly earlier than the control group [( 64. 1 ± 32. 0) hours vs.( 98. 1 ± 93. 1) hours,P = 0. 022]. The bilirubin levels of the study group upon admission and discharge were both significantly higher than those of the control group [( 266. 8 ± 73. 5) μmol /L vs.( 218. 9 ± 102. 6) μmol /L,P = 0. 002;( 193. 2 ± 23. 9) μmol /L vs.( 179. 6 ±25. 7) μmol/L,P =0.004]. The cycle of phototherapy was significantly more and duration of phototherapy significantly longer in the study group compared with the control group [( 2. 2 ± 1. 1) rounds vs.( 1. 4 ±0. 6) rounds,P < 0. 001;( 43. 1 ± 26. 1) hours vs.( 29. 1 ± 13. 1) hours,P = 0. 002]. The average length of hospital stay and the period before bilirubin level reducing to normal range were significantly longer in the study group than in the control group [( 4. 1 ± 3. 0) days vs.( 2. 5 ± 1. 2) days,P = 0. 002;( 43. 1 ± 25. 5) hours vs.( 33. 1 ± 14. 4) hours,P = 0. 021]. In addition,the incidence of hypoglycemia was significantly higher in the study group than in the control group( 16% vs. 10%,P = 0. 019). There was no significant inter-group differences in infection,hemolysis,or extravascular hemorrhage( all P > 0. 05). Conclusions Readmission for hyperbilirubinemia may be more likely to happen in infants with smaller gestational age,earlier occurrence of hyperbilirubinemia,higher level of bilirubin,longer duration of phototherapy,and hypoglycemia. Therefore,we suggest that the infants with the above-mentioned risk factors should be monitored for one more day after their bilirubin level decrease within the normal range,so as to prevent readmission.

关键词(KeyWords)： 新生儿;高胆红素血症;再入院;危险因素
neonate;hyperbilirubinemia;readmission;risk factors

Abstract:

Keywords:

基金项目(Foundation):

作者(Authors): 茹颖;王长燕;王薇;李正红;
RU Ying;WANG Chang-yan;WANG Wei;LI Zheng-hong;Department of Pediatrics,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences &Peking Union Medical College;

参考文献(References)：

• [1]Maisels MJ.Screening and early postnatal management strategies to prevent hazardous hyperbilirubinemia in newborns of35 or more weeks of gestation[J].Semin Fetal Neonatal Med,2010,15:129-135.
• [2]Dennery PA,Seidman DS,Stevenson DK.Neonatal hyperbilirubinemia[J].N Engl J Med,2001,344:581-590.
• [3]朴梅花,张慧.重视新生儿黄疸出院前评估及出院后随访[J].中华围产医学杂志,2010,15:641-643.
• [4]丁国芳,朴梅花.新生儿黄疸干预推荐方案[J].中华儿科杂志,2001,39:185-187.
• [5]Maisels MJ,Kring E.Length of stay,jaundice,and hospital readmission[J].Pediatrics,1998,101:995-998.
• [6]Burgos AE,Schmitt SK,Stevenson DK,et al.Readmission for neonatal jaundice in California,1991—2000:trends and implications[J].Pediatrics,2008,121:e864-e869.
• [7]De Luca D,Carnielli VP,Paolillo P.Neonatal hyperbilirubinemia and early discharge from maternity ward[J].Eur J Pediatr,2009,68:1025-1030.
• [8]Bhutani VK,Johnson L,Sivieri EM.Predictive ability of a predischarge hour-specific serum bilirubin for subsequent significant hyperbilirubinemia in healthy term and near-term newborns[J].Pediatrics,1999,103:6-14.
• [9]Skae MS,Moise J,Clarke P.Is current management of neonatal jaundice evidence based?[J].Arch Dis Child Fetal Neonatal Ed,2005,90:F540.
• [10]陈昌辉,李茂军,吴青,等.新生儿黄疸的诊断和治疗[J].现代临床医学,2013,39:154-160.
• [11]何麓郦,李强.新生儿黄疸的诊疗新进展[J].中国保健营养,2013,4:2179-2180.
• [12]Najati N,Gharebaghi MM,Mortazavi F.Underlying etiologies of prolonged icterus in neonates[J].Pak J Biol Sci,2010,13:711-714.
• [13]李莉,伊慧珍,尉进茜.453例足月新生儿高胆红素血症临床分析[J].中国当代医药,2012,19:38-41.
• [14]严荔煌,林忠,王山米.产科母婴同室足月新生儿黄疸的管理探讨[J].中国妇产科临床杂志,2009,10:119-122.