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目的随访评价新生儿期高直接胆红素血症(高直胆)预后对新生儿生长发育的影响。方法 2012年1月-2014年12月在丹阳市儿童医院新生儿科和丹阳市人民医院小儿科住院收治的新生儿高直胆患儿79例作为病例组,同期在该院儿保门诊查体的同病例组年龄、性别匹配的正常健康新生儿92例作为对照组,通过临床资料收集、儿童保健科医生现场问卷调查和临床预后健康检查,获得新生儿出生质量、婴幼儿一般情况、患儿高直胆患病情况、婴幼儿体格发育和智能发育情况。结果病例组患儿与对照组儿童性别、随访年龄、分娩方式均差异无统计学意义(P>0.05),但新生儿胎龄、出生体质量差异具有统计学意义(P<0.05)。病例组中,血Hbs Ag阳性率6.33%,7例梅毒TPPA阳性,尿或血CMV-PCR检查阳性38.89%。肝胆B超阳性率69.33%。30例在新生儿期有肠道外营养史。治愈和好转率66.67%,治疗前后血清胆红素相关生化指标差别有显著统计学意义。体格发育方面两组头围、体重及身高差别无统计学意义(P>0.05)。智能发育方面:病例组无论感觉还是运动发育均明显落后于对照组,差别有统计学意义(P<0.05)。结论新生儿高直接胆红素血症患儿临床预后较差,虽然未发现引起体格发育障碍,但是可引发明显的智能发育障碍。因此,应加强随访,早期积极干预,提高生存质量。
The purpose of follow-up evaluation of neonatal hyperbilirubinemia (high bile duct) prognosis of newborn growth and development. Methods From January 2012 to December 2014, 79 cases of infantile hyperbilirubinemia admitted to Department of Neonatology, Danyang Children’s Hospital and Pediatric Department of Danyang People’s Hospital were enrolled as case group. During the same period, Ninety-two healthy and normal neonates with matched age and gender were selected as control group. Through clinical data collection, on-site questionnaire and clinically prognostic health checkup of children’s health department, the newborns’ birth quality, infant’s general condition, Bile prevalence, physical development and intelligent development of infants and young children. Results There was no significant difference in sex, follow-up age and mode of delivery between the children in the case group and the control group (P> 0.05). However, there was a significant difference in gestational age and birth weight between the children and the control group (P <0.05). In the case group, the positive rate of HbsAg in blood was 6.33%, and the positive rate of TPPA in 7 cases of syphilis was 38.89% with urine or blood CMV-PCR. Hepatobiliary B-positive rate of 69.33%. Thirty patients had parenteral nutrition during the neonatal period. Cure and improvement rate of 66.67%, before and after treatment serum bilirubin-related biochemical indicators were statistically significant difference. Physical development in the two groups head circumference, weight and height difference was not statistically significant (P> 0.05). In the aspect of intelligent development, the case group was obviously lagging behind the control group both in sensory and motor development (P <0.05). Conclusion The clinical outcome of neonatal patients with high direct bilirubin is poor. Although no physical development disorder is found, it may cause obvious mental retardation. Therefore, we should strengthen follow-up, early positive intervention to improve the quality of life.