不同光疗方式对新生儿高胆红素血症疗效的观察

蓝光光疗因方法简便、疗效可靠,一直是新生儿高胆红素血症治疗的首选方法,但最近研究证实,蓝光照射时间过长可导致染色体损伤。本研究通过改变蓝光照射的方式,缩短了光疗时间,并与传统的持续光疗进行了疗效对照观察。一、对象和方法选择血清胆红素大于２０５．５μｍｏｌ／Ｌ并以间接胆红素增高为主的足月新生儿,男女不限,除外严重感染、肝脏疾病及遗传性疾病。按发病日龄、体重配对分为两组：间断光疗组：２８例,日龄（２．５±０．４）天,体重（３．２±０．６）ｋｇ;持续光疗组：２８例,日龄（２．９±０．７）天,体重（３．…     

早期新生儿高胆红素血症的防治

新生儿高胆红素血症是指新生儿在生后特定时间内血清总胆红素超过一定界限 ,以皮肤出现黄疸为临床表现 ,亦称新生儿黄疸 ,是新生儿早期常见的症状之一。新生儿黄疸原因复杂 ,有生理性和病理性之分。病理性黄疸可引起中枢神经系统受损 ,导致胆红素脑病 ,产生严重的后遗症 ,因此加强新生儿早期黄疸的观察 ,寻找病因 ,及时治疗尤为重要。1　分类1 1　生理性黄疸由新生儿胆红素代谢的特点所致 ,5 0 %以上足月儿和80 %以上早产儿于生后 2～ 3天出现黄疸 ,4～ 5天达高峰 ,足月儿 2周内 ,早产儿 3～ 4周可消退 ,一般状况良好 ,无其他临床症状。传统…     

新生儿早期吸吮时间与高胆红素血症的关系

新生儿早期吸吮时间与高胆红素血症的关系严荔煌王山米王吉善刘静洁母乳是０～６个月婴儿的最佳食品，但在新生儿早期因母乳不足时，高胆红素血症的发生率明显增高［１～３］。这无疑会引起产妇和医护人员的担忧［４］，影响４～６个月纯母乳喂养率。目前研究认为，频繁吸...     

建立新生儿重症高胆红素血症临床风险评估模型

目的 评价预测新生儿重症高胆红素血症风险方法的准确性,以建立最佳的新生儿重症高胆红素血症临床风险评估模型.方法 监测4907例足月儿和近足月儿的经皮胆红素,对经皮胆红素≥250 μmol/L者测量微量血胆红素.详细完整收集与母亲及新生儿相关的各项因素,运用Logistic回归模型评价各项因素与重症高胆红素血症发生风险的相关性,总结重症高胆红素血症的各项临床危险因素.利用以下3种策略估计新生儿重症高胆红素血症的发生风险,并采用受试者工作特性(receiver operating characteristic,ROC)曲线比较3种风险评估策略的预测准确性.3种风险评估策略分别为:(1)胆红素列线图上显示的出院前胆红素水平所在危险区域;(2)除出院前胆红素水平以外的临床危险因素;(3)出院前胆红素水平与临床危险因素两者结合.结果4907例新生儿中有286例(5.8%)发生了重症高胆红素血症.根据OR值将重症高胆红素血症的危险因素分为主要危险因素、次要危险因素和保护因素.主要危险因素包括出院前胆红素水平(生后72 h内)处于高危区(＞第95百分位数)(OR=96.39,95%CI:53.32～174.27,P=0.000),头颅血肿面积＞3 cm×3 cm(OR=36.45,95%CI:10.02～132.56,P=0.0076),胎龄35～36+6周(OR-30.72,95%CI:14.47～65.23,P=0.0001),纯母乳喂养且新生儿生后3 d体重下降＞出生体重的9%(OR=22.44,95%CI:4.42～114.03,P=0.0016).次要危险因素包括胎龄37～37+6周(OR-3.26,95%CI:1.92～5.55,P=0.0232),出院前胆红素水平位于第76～95百分位数(OR=13.64,95%CI:8.10～22.97,P=0.0001),皮下淤血(OR-2.32,95%CI:1.14～4.71,P=0.0497).保护因素包括出院前胆红素水平处于低危区(≤第40百分位数)(OR=0.00),胎龄≥40周(OR=0.21,95%CI:0.09～0.44,P=0.0402),混合喂养(OR=0.75,95%CI:0.58～0.95,P=0.0059).以胆红素曲线上的危险区域表示的出院前胆红素水平预测高胆红素血症的ROC曲线下面积为0.8687,临床危险因素预测的ROC曲线下面积为0.7375,两者结合ROC曲线下面积为0.9367.结论出院前胆红素水平所在胆红素列线图上的危险区域可以简单和较准确预测重症高胆红素血症的发生风险,将临床危险因素与之结合进行预测可以显著提高预测性.     

新生儿重度高间接胆红素血症脑脊液胆红素浓度测定及其临床意义

胆红素对神经系统具有毒性作用，当未结合胆红素在脑细胞沉积时可引起胆红素脑病，严重威胁新生儿的生命和健康。虽然高间接胆红素血症发生率很高，但有关脑脊液胆红素含量的报道很少。本研究探讨高间接胆红素血症(简称高胆)新生儿脑脊液胆红素含量及其影响因素和对预后判断的价值。     

156例新生儿高胆红素血症的心肌酶分析

目的:探讨新生儿高胆红素血症时心肌酶的变化及其意义。方法:对156例新生儿高胆红素血症患儿血清天冬氨酸氨基转移酶(AST)、乳酸脱氢酶(LDH-L)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、羟丁酸脱氢酶(HBDH)进行检测,同时选30例正常新生儿作对照,检测血清胆红素及心肌酶,并将检测结果进行统计学分析。结果:新生儿高胆红素血症患儿心肌酶明显高于对照组,差异具有统计学意义(P<0.01);新生儿高胆红素血症患儿经治疗后心肌酶明显降低,差异具有统计学意义(P<0.01)。结论:新生儿高胆红素血症可引起心肌酶升高,应将心肌酶列为常规检查项目。     

蓝光照射对高胆红素血症新生儿免疫系统的影响分析

目的：了解高胆红素血症新生儿在蓝光照射治疗前、后免疫系统的变化。方法：搜集2011年和2012年的高胆红素血症经蓝光治疗的新生儿的病历资料。分析治疗前、后的血胆红素、淋巴细胞亚群及NK细胞的变化。结果：与治疗前相比,治疗后的血胆红素水平下降明显;淋巴细胞亚群各指标及NK细胞上升明显。结论：蓝光照射对新生儿的高胆红素血症具有较好的治疗效果,同时还可有效地提高患儿的免疫力。     

新生儿高胆红素血症30例临床分析

目的：通过对治疗新生儿高胆红素血症患儿的临床疗效观察与分析,以便提高临床早期诊断,早期治疗效果,减少儿童脑瘫后遗症,提高我国人口素质。方法：选取30例新生儿高胆红素血症患儿,对患儿病例资料进行系统性分析,对所得数据进行整理与统计学处理,并对结果进行分析。结果：对早期诊断和早期治疗新生儿高胆红素血症效果明显提高,P〈0.05,且治疗副作用少。结论：早期诊断和早期治疗新生儿高但红素血症有较好的疗效,降低儿童脑瘫后遗症,提高我国人口素质。     

新生儿高胆红素血症89例临床分析

新生儿高胆红素血症是指新生儿血清胆红素浓度超过205μmol／L，或早产儿〉256μmol／L者，以间接胆红素升高为主，是新生儿期常见疾病之一。重者可致胆红素脑病，甚至危及新生儿生命，存活儿也可因中枢神经系统损害而致残。引起新生儿高胆红素的原因和诱因很多，且往往不是单一的，而是受多种因素的影响。     

脐血胆红素对ABO溶血病足月儿高胆红素血症的预测价值

目的 研究脐血胆红素水平预测ABO溶血病足月儿发生高胆红素血症的价值.方法 回顾性分析同济大学附属第一妇婴保健院新生儿科2011年8月1日至2012年7月31日收治的292例足月ABO溶血病患儿的脐血胆红素水平.比较发生高胆红素血症(高胆组,34例)和未发生高胆红素血症(非高胆组,258例)患儿的临床特征.采用配对f检验、x2检验和Spearman相关分析对数据进行分析.构建受试者工作特性(receiver operating characteristic,ROC)曲线,分析脐血胆红素水平预测高胆红素血症的准确度及界值(cut-off point). 结果 高胆组34例患儿平均脐血胆红素水平为(52.4±13.2) μmol/L,明显高于非高胆组的(35.0±8.0) μmol/L(t=7.540,P=0.001).脐血胆红素水平与高胆红素血症发生率明显相关(x2=113.715,P＜0.001; rs=7.19,P＜0.001).新生儿脐血胆红素水平为50μmol/L时,发生黄疸的阳性预测值为0.683,阴性预测值为0.959,敏感性为0.690,特异性为0.958,ROC曲线下面积为0.882 (95％CI:0.873～0.891,P＜0.001).结论 脐血胆红素水平可作为预测ABO溶血病足月儿发生黄疸及预测黄疸程度的有效指标.     

Reduction in serum paraoxonase level in newborns with hyperbilirubinemia as a marker of oxidative stress

Objective: Indirect bilirubin exerts an antioxidant effect when increased mildly. This study aimed to investigate whether increased bilirubin levels lead to an oxidant effect in newborns with hyperbilirubinemia requiring phototherapy.

Patients and methods: The study included 30 term newborn infants aged 0–7 days with indirect hyperbilirubinemia requiring phototherapy and no comorbid disease as the study group. In addition, 30 term healthy newborn infants aged 0–7 days without indirect hyperbilirubinemia were employed as a control group. Serum triglyceride, total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), serum paraoxonase (PON) levels and malondialdehyde (MDA) levels were compared between the groups.

Results: Serum MDA, total bilirubin, and LDL and HDL levels were significantly higher and the serum PON level was significantly lower, in the study group compared with the controls (p Conclusion: In newborns with hyperbilirubinemia requiring phototherapy, an increased bilirubin level causes oxidative stress by decreasing the level of serum PON and increasing the level of MDA.     

Treatment criteria for infants with hyperbilirubinemia in Japan

With the availability of blue light-emitting diode phototherapy devices capable of delivering high-intensity irradiance, neonatologists in Japan are requesting revisions of the 1992 Kobe University treatment criteria for hyperbilirubinemia using total serum/plasma bilirubin (TB) and serum unbound bilirubin (UB) threshold values, especially for indications for exchange transfusion (ET). Retrospective data analysis of 1,184 infants born between January 2012 and November 2014 when the 1992 criteria were followed, we applied revised criteria proposed in 2017 to these infants to assess consequent changes in treatment recommendations. We found that the estimated number of infants with ET indications decreases from 48 to 20, with intensive phototherapy recommended for the remaining 28. Also, the estimated number of infants with phototherapy indications decreases from 446 to 195. We conclude that use of the revised criteria will lead to judicious use and reduction of phototherapy and ET in infants with hyperbilirubinemia.     

高胆红素血症对新生儿T淋巴细胞亚群、血清可溶性白细胞介素-2受体变化趋势的影响和意义

目的 探讨新生儿高胆红素血症(简称高胆)时T淋巴细胞亚群和血清可溶性白细胞介素-2受体(soluble interleukin-2 receptor,sIL-2R)水平的变化趋势及其临床意义.方法 选择2006年12月1日至2007年1月31日住院的31例高胆新生儿作为高胆组,再根据黄疸程度分为重度黄疸组和轻度黄疸组;将其中16例随访病例按照病程分为黄疸高峰期与黄疸恢复期.选取同期与高胆组日龄相匹配的32例健康足月新生儿(无黄疸或血清胆红素水平≤204.0 μmol/L)作为与高胆组相对应的对照组(对照组Ⅰ);选取同期与黄疸恢复期病例日龄相匹配的26例健康足月新生儿(日龄＞7 d)作为与随访病例相对应的对照组(对照组Ⅱ).采用方差分析及两两检验比较各组血清胆红素、T淋巴细胞亚群、sIL-2R水平,并分析其间的相关性.结果 高胆组新生儿的CD3、CD4、CD4/CD8比值分别为(54.0±5.1)%、(26.8±5.0)%和0.8±0.1,较对照组Ⅰ[(62.0±4.7)%、(43.0±4.7)%和1.4±0.2]降低(P＜0.01);而黄疸恢复期较黄疸高峰期增高[(62.4±3.3)%和(55.1±4.2)%、(43.6±2.5)%和(26.1±4.4)%、1.4±0.1和0.8±0.1](P＜0.01);黄疸高峰期血清sIL-2R水平[(319.4±185.2)kU/L]高于黄疸恢复期[(129.7±99.3)kU/L]和对照组Ⅱ[(171.9±102.2)kU/L](P＜0.01).总体的血清胆红素水平与CD4/CD8比值呈负相关(r=-0.99,P＜0.01),与sIL-2R水平呈正相关(r=0.95,P＜0.05),sIL-2R水平与CD4/CD8比值呈负相关(r=-0.92,P＜0.05).结论 新生儿高胆时存在细胞免疫功能抑制状态,该抑制状态有随着黄疸消退而逐渐减轻的趋势.

Abstract：

Objective To investigate the dynamic changes and the clinical significance of T-cell subsets and serum soluble interleukin-2 receptor (sIL-2R)in neonates with hyperbilirubinemia.Methods Thirty-one neonates with hyperbilirubinemia, admitted to the hospital from Decembr 1,2006 to January 31, 2007, were enrolled and divided into two subgroups: severe jaundice group and mild jaundice group according to the bilirubin level. Thirty-two age-mached healty newborns were as controls(control group Ⅰ). The T-cell subsets and sIL-2R of peripheral venous blood samples from these neonates were measured and compared. Sixteen of these 31 neonates with hyperbilirubinemiawere followed up and another twenty-six age-mached healty newborns were as controls(control group Ⅱ ). The level of serum bilirubin in convalescence of sixteen hyperbilirubinemia neonates and control group Ⅱ were tested and analyzed also. Results The levels of CD3, CD4, CD4/CD8 in the neonates with hyperbilirubinemia were lower compared with those of control group Ⅰ [(54.0±5.1)% vs (62.0±4.7)%, (26.8±5.0)% vs (43.0±4.7)%, 0.8±0.1 vs 1.4±0.2] (P＜0.01), but was higher in convalescence than in peak phase[ (62.4±3.3)% vs (55.1±4.2)%, (43.6±2.5)% vs (26.1±4.4)%, 1.4 ± 0.1 vs 0.8±0.1] (P＜0.01). The peak level of sIL-2R in the hyperbilirubinemia group was (319.4± 185.2) kU/L, higher than that in the convalescence [(129.7±99.3) kU/L] and in the control group Ⅱ [(171.9±102.2) kU/L] (P＜0.01). The serum bilirubin level showed negative correlation with CD4/CD8 ( r = -0.99, P ＜ 0.01 ) and positive correlation with sIL-2R (r=0.95, P＜0.05). The sIL-2R level was negatively correlated with CD4/CD8 (r=-0.92, P＜0.05). Conclusions Neonates, when suffering from hyperbilirubinemia, are immunosuppressed which may recover with the alleviation of jaundice.     

早产儿预后研究进展

随着围产医学的发展及危重新生儿救治水平的提高,具有极限生存活力的早产儿存活率和生存质量已达较高水平。但早产儿死亡风险、严重后遗症的发生率与足月新生儿相比,仍存在差异。本文就早产儿的死亡率、死亡原因及远期预后,特别是呼吸系统和神经系统损害的远期预后等问题进行综合阐述。     

新生儿坏死性小肠结肠炎血浆谷氨酰胺浓度变化及临床意义

目的探讨血浆谷氨酰胺(Gln)浓度与新生儿坏死性小肠结肠炎(NEC)的关系。 方法选取2002年10月至2003年10月福建省妇幼保健院住院治疗的NEC患儿16例，以同期住院的性别相同，年龄、胎龄、出生体重相当的非NEC患儿16例为对照组，采用反向高效液相色谱法测定血浆Gln值，观察两组间差异；以多因素分析的方法判定血浆Gln浓度与NEC的关系。 结果NEC患儿血浆Gln浓度为(021±008)mmol/L，对照组为(035±014)mmol/L，差异有显著性意义(P<005)。控制了缺氧和感染因素的影响后，NEC组和对照组的血浆Gln浓度的边缘估计均值及95%可信区间分别为：0216mmol/L(0150~0282mmol/L)和0344mmol/L(0278~0410mmol/L)。两组校正均值比较，差异有显著性意义(P=0032)。在单因素分析筛选出关联因素的基础上，建立多因素条件Logistic回归模型，结果显示血浆Gln浓度是NEC的危险因素，OR值为13342(2006~88735)。 结论NEC患儿血浆Gln浓度降低，低浓度的血浆Gln是NEC发生的危险因素。     

Bone measurements of infants with hyperbilirubinemia by quantitative ultrasound: the influence of phototherapy

Objective: The purpose of the current study was to investigate the possible effects of phototherapy on bone status of term infants evaluated by measurement of tibial bone speed of sound (SOS).

Materials and methods: The phototherapy group (n?=?30) consisted of children who had undergone phototherapy for at least 24?h and the control group (n?=?30) comprised children who had not received phototherapy. Blood samples were obtained from all infants for serum calcium, phosphorus, magnesium, alkaline phosphatase, parathyroid hormone and vitamin D concentrations. The left tibial quantitative ultrasound (QUS) measurements were performed using a commercial device.

Results: There was no statistically significant difference between phototherapy-exposed and nonexposed infants in terms of Ca, P, ALP, PTH and vitamin D levels. Comparison of bone SOS between the phototherapy-exposed and control group revealed no statistically difference. Also, no significant difference in Z-score for SOS was observed between those with or without exposure.

Conclusion: The data of our study indicate that phototherapy treatment has no impact on bone status in the hyperbilirubinemic infants. Although there is no statistically significant evidence of an excess risk of bone damage following phototherapy, studies with larger sample sizes and longer duration of follow-up are needed to gain a better understanding of its effects.