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目的从地区因素、胎儿和孕母三个方面探讨不同基本情况新生儿高胆红素血症发生的差异,为临床防治提供依据。方法使用修订问卷,分层整群随机抽样的方法调查全国14市的14家三甲医院2012-2014年间出生的16 766名新生儿,收集信息包括:新生儿和孕母基本情况、生产过程及危险症、临床检查及主要生化指标(胆红素含量)等。卡方(或卡方分割)的方法分析不同情况新生儿疾病发生率的差异,并两两比较全国7个地区发生率的差异。结果胎儿性别、胎龄、出生体重孕妇分娩方式、孕产史、是否胎膜早破、生后1min内Apgar评分、首次胎便时间对疾病发生影响显著(P<0.05);中国华东>西南>东北、西南>西北、东北>华中,发病率两两比较差异有统计学意义(P<0.01);多因素回归分析,影响大小依次为:胎膜早破EXP(B)=1.15、胎儿性别EXP(B)=1.12、孕妇产史EXP(B)=0.89、出生地区EXP(B)=0.79、分娩方式EXP(B)=0.54。结论新生儿高胆红素血症的发生存在地域特征,从胎儿和孕妇基本情况能预测该疾病的发生风险。
Objective To investigate the differences of neonatal hyperbilirubinemia in different basic conditions from three aspects: regional factors, fetuses and pregnant mothers, so as to provide basis for clinical prevention and treatment. Methods A total of 16 766 newborns born in 14 top three hospitals in 14 cities across the country from 2012 to 2014 were surveyed by using the revised questionnaire and stratified cluster random sampling method. The collected information includes the basic information of newborns and pregnant mothers, the production process and the risks Disease, clinical examination and the main biochemical indicators (bilirubin content) and so on. Chi-square (or chi-square split) method to analyze the differences in the incidence of neonatal diseases in different situations, and compare the incidence of differences in seven regions across the country. Results Fetal sex, gestational age, gestational age at birth, pregnancy history, premature rupture of membranes, Apgar score within 1 minute after birth, the time of first defecation had a significant effect on the disease (P <0.05); East China> Southwest> Northeast China (P <0.01). The multivariate regression analysis showed that the impact size was: the premature rupture of membranes (EXP) = 1.15, the fetal sex of EXP B = 1.12, birth history EXP (B) = 0.89, birth area EXP (B) = 0.79, mode of delivery EXP (B) = 0.54. Conclusions The occurrence of neonatal hyperbilirubinemia is characterized by regional characteristics. The basic risk factors of fetal hyperbilirubinemia can be predicted from the fetus and pregnant women.