中西医结合治疗新生儿高胆红素血症231例临床观察

目的探讨中药茵栀黄联合西医常规（病因治疗、蓝光照射、静脉输注白蛋白或血浆等）治疗新生儿高胆红素血症的临床疗效。方法茵栀黄加西医常规（病因治疗、蓝光照射、静脉输注白蛋白或血浆等）治疗。结果231例患儿茵栀黄加西医常规（病因治疗、蓝光照射、静脉输注白蛋白或血浆等）治疗后有嗜睡、呕吐症状消失，二便正常，皮肤及巩膜黄疸6～20天消退，血清总胆红素平均6～8天（171例）、8～10天（41例）、10～20天（14例）降至正常值，5例未降至正常值（因自动出院）。结论早期发现并及时应用中药茵栀黄注射液，配合西医常规治疗新生儿高胆红素血症，可明显缩短病程并预防核黄疸发生。     

光导纤维光疗毯绿光照射治疗新生儿高胆红素血症疗效观察

我院自 1997年 7月开始采用光导纤维光疗毯 (简称光纤毯 )绿光照射治疗新生儿高胆红素血症 ,并与蓝光箱蓝光照射进行比较 ,现报告如下。临床资料 :随机选择新生儿高胆红素血症患儿 80例。其中 ,采用光纤毯绿光照射治疗 (简称绿光组 ) 4 0例 ,治疗前血清胆红素为 (2 84 37± 6 1 34 )μｍｏｌ/Ｌ ;采用蓝光箱蓝光照射治疗组(简称蓝光组 ) 4 0例 ,治疗前血清胆红素为 (2 89 19± 5 9 16 ) μｍｏｌ/Ｌ。两组患儿均为母乳喂养。两组病例日龄、胎龄、出生体重、性别、治疗前血清胆红素水平 ,经统计学处理均无显著差异(Ｐ >0 0 5 )。治疗方法 :…     

新生儿高胆红素血症的临床分析

目的 总结新生儿高胆红素血症的治疗经验.方法 2006年至2007年住院患儿共100例,男48例,女52例,给予蓝光照射、白蛋白、营养心肌等综合治疗.结果 所有病例经综合治疗,黄疸消退,多脏器损害基本恢复正常.结论 病理性黄疸经积极治疗,能有效避免对多脏器的损害.     

LED蓝光对早产儿早期黄疸干预的疗效观察

目的 比较LED蓝光与普通蓝光灯照射治疗早产儿黄疸的疗效.方法 以新生儿科收治的胎龄在35～37周的早产儿180例为研究对象,入院后从出生后8h起每2小是时监测早产儿黄疸变化情况,当血清总胆红素≥P95后予以光疗.根据患儿人院顺序分成两组：观察组予以LED蓝光照射,当光疗间隙期血清总胆红素≤P40后停止光疗;对照组予以普通单面荧光蓝光灯管照射,当光疗间隙期血清胆红素≤P40时停止光疗.观察患儿黄疸消退的时间,以及腹泻、皮疹、发热等不良反应情况.结果 观察组黄疸消退时间明显短于对照组,差异有统计学意义（P＜0.01）;观察组皮疹、腹泻及母乳减少等发生率较对照组减少（P＜0.05）.结论 LED蓝光照射治疗早产儿黄疸疗效高于普通荧光蓝光灯,且发热、皮疹、腹泻等不良反应减少.     

新生儿高胆红素血症85例临床分析

目的 总结新生儿高胆红素血症的治疗及预后，重点分析本地区高胆的病因。方法 收集该院近期85例新生儿高胆红素血症，采用回顾性调查方法加以分析。结果 经蓝光照射、静点白蛋白、口服药物等综合治疗。82例治愈，治愈率96.47％。高胆的病因依此为感染性因素46例(54．11％)，非感染因素35例(41．18％)，原因不明者4例(4．71％)。结论 新生儿高胆经综合治疗，愈后良好。本地区高胆红素血症因以感染为主，围产期因素及母乳性黄疸占重要地位。     

浅谈新生儿黄疸的护理

新生儿黄疸是指新生儿时期血清胆红素浓度增高，分生理性黄疸及病理性黄疸。血清胆红素浓度超过256ml／L即为病理性黄疸，超过342umol／L即可发生核黄疸。核黄疸可导致呼吸衰竭、肺出血而危及患儿生命。因此，临床上降低病理性黄疸患儿血清胆红素浓度是至关重要的。现就有关的治疗及护理介绍如下：     

蓝光强度与光疗效果的观察

光疗是治疗新生儿高胆红素血症的有效方法[1],其疗效与光的强度关系密切[2]。本文介绍20例新生儿高胆红素血症,光疗时光的强度与疗效之间的关系,现报告如下一、对象与方法20例新生儿高胆红素血症患儿均为住院病例,其中男性13例,女性7例。日龄1～11天,平均5.4±3.2天。采用上海合力医疗器械厂生产的蓝光治疗机,每个病儿置蓝光箱照射前,先以Minolta Fluor-LiteMeter 451型的光强度测定仪,分别测定正反两面     

浅谈对新生儿生理性黄疸的护理

新生儿生理性黄疸是指新生儿因体内血清胆红素浓度增高而引起的巩膜、面部、皮肤、黏膜的黄染。轻度黄染的婴儿护理我们要加强母乳喂养宣教和有成效的经验交流，还要加强对皮肤的护理。对于中度及重度黄疸我们要加强用蓝光治疗方法时的护理措施。     

双歧杆菌活菌制剂治疗新生儿母乳性黄疸的疗效

目的观察双歧杆菌活菌制剂治疗新生儿母乳性黄疸的疗效。方法对63例新生儿母乳性黄疸患儿随机分为双歧杆菌治疗组和常规治疗组,常规治疗组采用输液、清蛋白静滴,重者采用蓝光治疗;双歧杆菌治疗组在常规治疗方法基础上加用双歧杆菌活菌制剂,并观察两组患儿黄疸消褪时间及血清总胆红素水平的变化。结果双歧杆菌治疗组和常规治疗组黄疸消褪时间分别为(4.0±2.1)、(5.5±2.5)d,两组比较有显著差异(P<0.05),治疗d5血清总胆红素值分别为(45.6±17.3)(、82.5±32.6)μmol/L,两组比较有极显著差异(P<0.01)。结论双歧杆菌活菌制剂治疗新生儿母乳性黄疸有显著疗效。     

苯巴比妥与尼可刹米联合治疗重症母乳性黄疸569例

新生儿黄疸又称新生儿高胆红素血症。新生儿出生后都会发生或轻或重的黄疸。新生儿黄疸大多属于生理性黄疸。占足月儿的50％，早产儿的90％。病理性黄疸少见，病因复杂。近年来发现一种介于病理性和生理性黄疸之间的黄疸。随母乳喂养的频率的增加而增加，称为母乳性黄疸。母乳性黄疸大多无需特殊治疗，我科收治的569例黄疸患儿，其中83例较重，胆红素〉12mg,／dl，1min胆红素〉200mg／dl，笔者采用了苯巴比妥加尼可刹米联合停母乳喂养治疗，收到了好的效果，现报告如下。     

Neonatal jaundice and splenic hematoma

In the newborn period, unconjugated hyperbilirubinemia (UHB) is common, multifactoral, and associated with a variety of physiologic and pathologic conditions. The most commonly identified pathologic cause leading to hyperbilirubinemia is hemolytic disease of the newborn. We report a five-days-old female infant with neonatal jaundice secondary to splenic hematoma.     

Transcutaneous bilirubinometry in neonatal intensive care units.

AIMS: To study the influence of several clinical and paraclinical factors on the association between jaundice meter readings and plasma bilirubin concentration; and to comment on the usefulness of the jaundice meter as a screening device for hyperbilirubinaemia in neonatal intensive care units. METHODS: Three hundred and seventy seven newborn babies admitted to the neonatal intensive care unit for various causes were included in the study. When the plasma bilirubin concentration needed to be determined for clinical reasons, the extent of the yellow skin colour was measured transcutaneously, using a jaundice meter. The haemoglobin concentration was also determined. This had no independent influence on the jaundice meter readings. The yellow skin colour was significantly and positively correlated with the bilirubin concentration and the presence of respiratory distress syndrome (RDS), and negatively with gestational age and postnatal ages. CONCLUSIONS: These findings were interpreted as being due to variations in the ability of albumin to bind bilirubin, and in the basal yellow skin colour. It was impossible to derive simple criteria for detection of hyperbilirubinemia by jaundice meter readings in this study group.     

Jaundice in the newborns

Hyperbilirubinemia is the commonest morbidity in the neonatal period and 5–10% of all newborns require intervention for pathological jaundice. Neonates on exclusive breast-feeding have a different pattern and degree of jaundice as compared to artificially fed babies.. Latest guidelines from American Academy of Pediatrics (AAP) for management of jaundice in a normal term newborn have been included in the protocol. Separate guidelines have been provided for the management of jaundice in sick term babies, preterm and low birth weight babies, for hemolytic jaundice and prolonged hyperbilirubinemia.     

A novel inborn error of metabolism detected by elevated methionine and/or galactose in newborn screening: neonatal intrahepatic cholestasis caused by citrin deficiency

Adult-onset type II citrullinaemia, caused by deficiency of the citrin protein encoded by the SLC25A13 gene, is characterised by a liver-specific argininosuccinate synthetase deficiency. DNA analysis for citrin deficiency revealed that SLC25A13 mutations are the cause of a particular type of neonatal intrahepatic cholestasis. We retrospectively investigated nine infants with cholestatic jaundice of unknown origin, detected by newborn screening over a period of 17 years, to determine the role of SLC25A13 defects in children. The results of the newborn screening were varied; four neonates were positive for hypermethioninaemia, two for hyperphenylalaninaemia, one for hypergalactosaemia and two for both hypermethioninaemia and hypergalactosaemia. Clinical characteristics of the patients were severe intrahepatic cholestasis, hypercitrullinaemia, and fatty liver. The symptoms resolved in all patients by 12 months of age without special treatment other than nutritional management. Although five patients were lost to follow-up, we detected SLC25A13 mutations in the remaining four patients examined. CONCLUSION: the differential diagnosis of cholestatic jaundice of unknown origin in infants should therefore include citrin deficiency. In this paper, we stress the importance of newborn screening to detect infants with neonatal intrahepatic cholestasis caused by citrin deficiency.     

Hyperbilirubinemia in the newborn

After completing this article, readers should be able to: 1. List the risk factors for severe hyperbilirubinemia. 2. Distinguish between physiologic jaundice and pathologic jaundice of the newborn. 3. Recognize the clinical manifestations of acute bilirubin encephalopathy and the permanent clinical sequelae of kernicterus.4. Describe the evaluation of hyperbilirubinemia from birth through 3 months of age. 5. Manage neonatal hyperbilirubinemia, including referral to the neonatal intensive care unit for exchange transfusion.     

Hemolytic Disease of the Newborn- Anti c Antibody Induced Hemolysis

Hemolytic disease in the newborn, as a cause of early jaundice, is not uncommon. This is mostly due to Rh (D), ABO incompatibility and rarely due to other minor blood group incompatibility. The authors report two cases of Rh anti c isoimmunization presenting as significant early neonatal jaundice within the 20 h of life. Both the babies were treated with intensive phototherapy. One baby underwent exchange transfusion and the other required packed cell transfusion for anemia.     

Neonatal jaundice: Its prevalance in Chinese babies and associating factors

A prospective study of 1238 full-term Chinese newborn infants was conducted to determine the incidence of neonatal jaundice and associated factors. A significantly more severe degree of hyperbilirubinaemia was present in infants whose ABO blood group was incompatible with that of their mothers and those who were deficient in the enzyme glucose-6-phosphate dehydrogenase (G6PD). Among the remainder, clinical jaundice was present in 87% and 23.9% had a peak serum bilirubin (SB) concentration greater than 204 mol/l. Factors that were found to have an association with a higher peak SB concentration included: male infants; elder siblings who had a history of neonatal jaundice; and breast-fed infants with or without supplementation with formula feed. Factors that were found to have no significant association with the peak SB concentration were: gestational age; birthweight; the mode of delivery of the infants; maternal consumption of Chinese herbs and syntocinon induction or augmentation of labour.     

Neonatal jaundice: its prevalence in Chinese babies and associating factors

A prospective study of 1238 full-term Chinese newborn infants was conducted to determine the incidence of neonatal jaundice and associated factors. A significantly more severe degree of hyperbilirubinaemia was present in infants whose ABO blood group was incompatible with that of their mothers and those who were deficient in the enzyme glucose-6-phosphate dehydrogenase (G6PD). Among the remainder, clinical jaundice was present in 87% and 23.9% had a peak serum bilirubin (SB) concentration greater than 204 mumol/l. Factors that were found to have an association with a higher peak SB concentration included: male infants; elder siblings who had a history of neonatal jaundice; and breast-fed infants with or without supplementation with formula feed. Factors that were found to have no significant association with the peak SB concentration were: gestational age; birthweight; the mode of delivery of the infants; maternal consumption of Chinese herbs and syntocinon induction or augmentation of labour.     

Transcutaneous Bilirubinometry in Normal Japanese Infants

We performed TcB readings in healthy full-term breast-fed Japanese infants from birth to seven days, and attempted to establish the normal range. TcB readings from Japanese infants were significantly higher over a longer period compared with Caucasian infants. The age of peak TcB readings in Japanese newborn infants was day 6, significantly later than that of Caucasian infants, day 3–4. We also attempted to estimate the total serum bilirubin concentrations using regression line relating TcB readings to serum bilirubin concentrations. Our study demonstrated that estimated total serum bilirubin concentration from forehead TcB readings was 0.56 ± 0.35 mg/dl at birth, thereafter increasing to 6.8 ±0.5 mg/dl on day 1 and reaching a maximum of 12.6 ± 2.5 mg/d on day 6.These values and pattern in Japanese neonatal jaundice were significantly different from those of Caucasian children, but were similar to values and patterns from American Indians, Alaskan Eskimo, and other Asian full-term newborn infants. Thus TcB measurement may be useful for observation of the course of neonatal jaundice.     

The natural history of neonatal jaundice

The relationship between infant feeding type and the occurrence and natural history of neonatal jaundice in term newborn infants has been studied. A retrospective chart review of 124 records confirmed earlier reports indicating that jaundice is recognized more often in breast-fed than in formula-fed infants. A prospective cohort study of 140 term newborn infants was conducted using the Minolta Air-Shields transcutaneous jaundice meter. For 3 weeks, 115 white infants and 25 black infants were followed at predetermined intervals. The peak jaundice meter readings were higher and the elevated levels lasted longer in breast-fed than in formula-fed infants. Formula-fed infants' readings returned to base-line levels in eight days whereas the readings were still elevated in breast-fed infants when the study ended on the 21st day. Black infants had higher transcutaneous readings than white infants due to their deeper skin pigmentation, but otherwise they followed a course identical with that of the white babies. The distribution of jaundice in the white infants was bimodal; in approximately one fourth of the breast-fed infants, the jaundice meter readings reached levels corresponding to bilirubin values greater than 13 mg/dL whereas the remaining three fourths followed a pattern similar to that of the formula-fed infants. It can be concluded that human milk feeding is associated with more prolonged hyperbilirubinemia than formula-feeding in normal term infants.