胆红素脑病患儿内在因素及外在高危因素分析

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目的探讨新生儿胆红素脑病患儿自身伴发疾病及外在高危因素。方法选择2005年1月至2013年12月本院新生儿科收治的胆红素脑病患儿,记录患儿一般情况、围产期高危因素、伴随疾病及外在高危因素。结果 9年间共收治胆红素脑病患儿52例,胎龄(38.3±2.3)周,出生体重(3 013±483)g,入院日龄(6.7±4.3)天,血清总胆红素(543.6±122.7)μmol/L,血清总胆红素/血浆白蛋白(B/A)比值为(0.96±0.15)。52例胆红素脑病患儿中有明确伴发疾病者44例(占84.6%),其中最常见的伴发疾病是新生儿感染,共30例(57.7%),其次为葡萄糖-6-磷酸脱氢酶缺乏症22例(42.3%),有多重伴发疾病19例(36.5%)。有50例患儿存在外在诱因(96.2%),其中26例患儿家属未按要求进行出院3天后随访;12例患儿产科出院时存在高胆红素血症,但家人拒绝住院治疗;10例患儿出院时黄疸程度不重,在家喂服中药或外洗后导致黄疸加重。结论外在高危因素是新生儿发生胆红素脑病的主要原因,根据调查分析结果针对不同高危因素,对新生儿父母进行黄疸危害的宣传,黄疸治疗方法教育、建立规范的随访时间和及时发现感染是减少新生儿胆红素脑病的主要预防措施。 Objective To explore neonatal bilirubin encephalopathy in children with their own disease and external risk factors. Methods Children with bilirubin encephalopathy admitted to neonatology department of our hospital from January 2005 to December 2013 were enrolled. The general condition, perinatal high risk factors, concomitant diseases and external high risk factors were recorded. Results A total of 52 children with bilirubin encephalopathy were enrolled in this study. The gestational age (38.3 ± 2.3) weeks, birth weight (3 013 ± 483) g, date of admission (6.7 ± 4.3) days, serum total bilirubin ± 122.7) μmol / L, and the ratio of serum total bilirubin / plasma albumin (B / A) was (0.96 ± 0.15). Among 52 children with bilirubin encephalopathy, 44 patients (84.6%) had definite concomitant disease. The most common concomitant disease was neonatal infection (30.7%), followed by glucose-6-phosphate There were 22 cases (42.3%) of dehydrogenase deficiency and 19 cases (36.5%) with multiple concomitant diseases. There were 50 cases of external incentive (96.2%), of which 26 cases of family members were not discharged as required after 3 days follow-up; 12 cases of obstetric discharge of children with hyperbilirubinemia, but the family refused to hospitalization; 10 cases of children discharged at the time of jaundice is not heavy, at home after serving Chinese medicine or external wash caused jaundice increased. Conclusions External risk factors are the main cause of neonatal bilirubin encephalopathy. According to the investigation and analysis of the results for different risk factors, the parents of jaundiced neonatal hazards, education jaundice treatment, establish a standardized follow-up time and timely detection of infection Is to reduce neonatal bilirubin encephalopathy the main preventive measures.
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