Hyperbilirubinemia in the healthy term newborn

Jaundice is a common clinical problem in newborns. Although the need to diagnose and treat hyperbilirubinemia in the healthy term newborn has been controversial, recent reports of detrimental neurologic effects from elevated serum bilirubin levels in the healthy newborn make such scrutiny prudent. Until 1994, when the American Academy of Pediatrics developed guidelines for managing hyperbilirubinemia in the healthy term newborn, no standard of care was defined.     

新生儿高胆红素血症心肌酶谱活性的变化

目的 对高胆红素血症新生儿心肌损害作出早期诊断.方法 对42例新生儿血清天冬氨酸氨基转移酶(AST)、乳酸脱氢酶(LDH)、肌酸磷酸激酶(CK)和肌酸磷酸激酶同工酶(CK-MB)定量测定.结果 高胆红素组新生儿心肌酶谱测定值较对照组明显增高,差异有统计学意义,并与黄疸程度成正比.结论 心肌酶谱活性检测可作为高胆红素血症新生儿心肌损害早期灵敏、特异的重要诊断指标,临床上有重要实用价值.     

新生儿黄疸期血清总胆汁酸测定的临床价值

目的通过检测血清总胆汁酸（TBA）水平，探讨其在新生儿黄疸诊断治疗中的意义。方法采用日立7060全自动生化分析仪对40例新生儿血清总胆红素（TBIL）和血清TBA进行定量测定。结果高胆红素组新生儿血清TBA测定值较30例对照组明显增高，差异有统计学意义（P〈0．01），并与黄疸程度呈正比。结论血清TBA测定在新生儿黄疸实验室诊断中具有较好的特异性和灵敏性，可为临床提供诊断和治疗依据。     

抚触在高胆红素血症新生儿中应用的研究进展

从抚触的概念、研究历史、手法、对高胆红素血症新生儿的作用及机制和抚触手法、力度、部位、时机、次数对高胆红素血症新生儿的影响等方面综述了抚触在高胆红素血症新生儿中应用的研究进展.     

高未结合胆红素血症新生儿血清肌酸激酶同工酶的测定及意义

目的　探讨肌酸激酶同工酶（ Ｃ Ｋ Ｂ Ｂ） 作为诊断新生儿高未结合胆红素血症合并脑细胞损害的应用价值。方法　采新生儿外周血，连续观察３０ 例高未结合胆红素血症新生儿和５９ 例正常新生儿血清中 Ｃ Ｋ Ｂ Ｂ 水平。结果　高未结合胆红素血症新生儿血清中 Ｃ Ｋ Ｂ Ｂ 明显高于正常对照组，是正常新生儿的２６ 倍， Ｐ＜ ０ ．００１ ， Ｃ Ｋ Ｍ Ｂ 组亦明显高于正常组，但其幅度低于 Ｃ Ｋ Ｂ Ｂ 组， Ｃ Ｋ Ｍ Ｍ 组明显低于 Ｃ Ｋ Ｂ Ｂ 组。但高未结合胆红素血症患儿血清中 Ｃ Ｋ Ｂ Ｂ水平与总胆红素相关性差，ｒ＝ ０ ．２２２ ， Ｐ＝ ０ ．０５ 。结论　新生儿血清 Ｃ Ｋ Ｂ Ｂ 增高与高未结合胆红素血症造成的脑细胞损害有关， Ｃ Ｋ Ｂ Ｂ 可作为临床监测高未结合胆红素血症新生儿胆红素脑病的一个筛选指标，值得临床推广。     

MRI联合血清脑源性神经营养因子及神经元特异性烯醇化酶对高胆红素血症患儿诊断及转归的临床价值

目的探索MRI联合血清脑源性神经营养因子（BDNF）、神经元特异性烯醇化酶（NSE）对高胆红素血症患儿诊断及转归的临床意义。方法选取2017年3月~2019年8月在本院住院患有高胆红素血症的新生儿60例作为研究对象，其中男34例，女26例，胎龄38.4±1.6周；同期选取在本院住院的新生儿40例作为对照组，男19例，女21例，胎龄37.8±1.5周，比较两组新生儿血清BDNF、NSE水平及转归情况；根据MRI影像学表现，将高胆红素血症患儿分为MRI异常组和MRI正常组，比较血清BDNF、NSE水平；考察MRI、BDNF、NSE作为诊断高胆红素血症的诊断价值。结果高胆红素血症组临床转归总有效率为50.00%，低于对照组的75.00%，两组转归有效率的差异具有统计学意义（P < 0.05）。高胆红素血症组中54例（90.00%）患儿见MRI信号异常；对照组中6例（15.00%）见头颅MRI异常，差异有统计学意义（P < 0.05）。高胆红素血症组患儿NSE、BDNF表达均高于对照组（P < 0.05）。MRI异常组患儿血清NSE和BDNF水平高于MRI正常组（P < 0.05）。MRI联合血清BDNF、NSE对高胆红素血症的诊断效果高于单因素诊断。结论MRI联合血清NSE、BDNF可为高胆红素血症患儿的早期诊断及转归提供观察依据。      

Nursing diagnoses of hospitalized infants with physiologic hyperbilirubinemia: A cross sectional study

Background and aimNursing diagnoses are the common language of nurses which indicate the labels given to human responses to health problems/developmental processes. Neonatal physiologic hyperbilirubinemia is a developmental disorder common in neonates. The responses to this health problem need to be identified.This study aimed to find physiologic hyperbilirubinemia related nursing diagnoses in some domains of the NANDA-I classification in hospitalized newborns in a maternal-neonatal educational hospital in Tehran, Iran.MethodsIn this cross-sectional study, a checklist contains labels, defining characteristics and related factors of selected nursing diagnosis of six domains of the NANDA-I classification and a maternal-neonatal information questionnaire were used for conveniently selected 140 hospitalized newborns with physiologic hyperbilirubinemia. The data was analyzed using SPSS software 23 (IBM Corp, Armonk, NY).FindingsRisk for deficient fluid volume, Risk for electrolyte imbalance (hyponatremia/hypocalcemia/hypernatremia), risk for vascular trauma, risk for impaired skin integrity, risk for infection, risk for injury (retinal damage/bilirubin hyperbilirubinemia) and risk for thermal injury were the nursing diagnoses identified for more than 90% of the neonates.ConclusionThe nursing diagnoses identified in this study for physiologic neonatal hyperbilirubinemia can guide clinical neonatal nurses in providing high-quality care in neonatal settings.     

新生儿高胆红素血症尿RBP检测意义的探讨

目的探讨尿视黄醇结合蛋白(RBP)在新生儿高胆红素血症时的浓度变化及其检测在判断新生儿肾脏损伤状况和治疗过程中的临床意义。方法选择患高胆红素血症的住院新生儿(足月顺产)38例,分别于入院时、治疗中期、治疗后期及出院前四个阶段用经皮胆红素测定仪测定胆红素浓度,并同时收集新鲜尿液,采用ELISA方法检测尿RBP浓度,同时与30例正常新生儿的尿RBP浓度比较。结果高胆红素血症组的尿RBP为412.5±165.3μg/L,正常对照组为168.8±109.7μg/L,前者明显高于后者,两组间存在非常显著性差异(P<0.01)。高胆红素组四个阶段的尿RBP(μg/L)和胆红素浓度(μmol/L)分别为:412.5±165.3、318.5±129.8;301.6±115.1、223.6±104.4;229.1±108.9、169.7±87.6;172.7±98.3、113.2±51.5。显示尿RBP浓度随着胆红素浓度的高低而变化,呈现显著的正相关。结论尿RBP检测是一项监测肾功能损害的灵敏指标,对新生儿高胆红素血症时的肾功能损害监测和疗效判断都具有很实用的临床意义。     

两种干预对高胆红素血症新生儿情绪和睡眠的影响

[目的]探讨两种干预对高胆红素血症新生儿情绪和睡眠时间的影响。[方法]将68例高胆红素血症新生儿随机分为A组和B组,A组按常规治疗护理,间断蓝光照射48h,分4d进行,B组在A组基础上施以抚触,每天2次,每次15min,分别于光疗初期及后期进行,观察两组患儿4d内哭闹及睡眠情况。[结果]B组哭闹次数明显少于A组,每日睡眠时间明显多于A组。[结论]常规干预加抚触有利于稳定患儿的情绪,提高睡眠质量。     

早期新生儿黄疸动态监测与干预治疗效果观察

目的评价早期监测新生黄疸早期干预治疗的临床效果。方法对新生儿进行黄疸动态监测,记录相关数据分析胆红素峰值出现的时间规律。对动态监测中发现的血清胆红素值超标的患儿给予早期干预治疗,并统计高胆红素血症的患病率与2003年全年未实施早期新生儿黄疸的动态监测与干预治疗时期的高胆红素血症患病率进行对比,以客观评定新生儿黄疸的动态监测与干预治疗的意义。结果对照组高胆红素血症发生率为36.93%,观察组为15.21%;对照组胆红素脑损伤的发生率为4.05%,观察组无脑损伤病例报告。结论动态监测可尽早发现新生儿血清胆红素水平的异常,为尽早干预治疗提供了保障。早期干预治疗极大地降低了高胆红素血症的患病率,有效预防新生儿胆红素脑损伤的发生。     

新生儿高胆红素血症血清神经元特异性烯醇化酶检测临床意义分析

目的通过检测新生儿高胆红素血症患儿血清神经元特异性烯醇化酶(NSE)的变化,探讨NSE早期诊断新生儿胆红素脑病的意义。方法 36名健康新生儿和96名本院新生儿室收治的高胆红素血症患者生后3-7天静脉采血检测血清胆红素和γ-GGT、NSE水平,同时做脑干听觉诱发电位(BAEP)检测,分析统计不同胆红素水平下NSE和BAEP、γ-GGT的变化。结果 NSE水平在胆红素重度升高、中度升高、轻度升高组均增高,各组间及与对照组间差异有显著性,P<0.05。BAEP异常和γ-GGT升高在轻度升高组与对照组、重度升高组与中度升高组之间差异有显著性,但在轻度升高组与中度升高组之间差异无显著性。结论血清NSE水平较BAEP及γ-GGT检测来判断新生儿胆红素脑病更早、更敏感,NSE可作为判断高胆红素血症新生儿发生脑病早期诊断指标之一。     

Hyperbilirubinemia in the term newborn

Hyperbilirubinemia is one of the most common problems encountered in term newborns. Historically, management guidelines were derived from studies on bilirubin toxicity in infants with hemolytic disease. More recent recommendations support the use of less intensive therapy in healthy term newborns with jaundice. Phototherapy should be instituted when the total serum bilirubin level is at or above 15 mg per dL (257 micromol per L) in infants 25 to 48 hours old, 18 mg per dL (308 micromol per L) in infants 49 to 72 hours old, and 20 mg per dL (342 micromol per L) in infants older than 72 hours. Few term newborns with hyperbilirubinemia have serious underlying pathology. Jaundice is considered pathologic if it presents within the first 24 hours after birth, the total serum bilirubin level rises by more than 5 mg per dL (86 micromol per L) per day or is higher than 17 mg per dL (290 micromol per L), or an infant has signs and symptoms suggestive of serious illness. The management goals are to exclude pathologic causes of hyperbilirubinemia and initiate treatment to prevent bilirubin neurotoxicity.     

2种不同时间蓝光照射法对新生儿高胆红素血症的影响

目的探讨两种不同时间蓝光照射法对新生儿高胆红素血症的效果。方法将130例高胆红素血症新生儿随机分为对照组和观察组,每组65例,分别采用持续蓝光照射法和间歇蓝光照射法。比较两组患儿退黄效果、每天胆红素下降幅度和疗程。结果两组患儿退黄效果、每天胆红素下降幅度、疗程比较,经统计学分析,均P>0.05,差异无统计学意义。结论间歇蓝光照射治疗新生儿高胆红素血症疗效满意,提高患儿心理上的满足与身体的舒适。     

Association of transcutaneous bilirubin testing in hospital with decreased readmission rate for hyperbilirubinemia

BACKGROUND: Newborns are being discharged from hospitals within 1-2 days of birth, before hyperbilirubinemia usually becomes clinically evident. We investigated the use of transcutaneous bilirubin (TcB) before discharge to determine whether it affects the use of laboratory bilirubin testing or decreases the number of neonates readmitted for hyperbilirubinemia within 7 days of initial discharge. METHODS: We retrospectively searched a clinical laboratory and hospital database to determine the number of births, newborn readmission rates for hyperbilirubinemia, length of stay, and the number of bilirubin measurements in the clinical laboratory ordered for all babies in the newborn unit at the University of Texas Medical Branch from August 2002 to March 2003 (before TcB testing) and from May 2003 to December 2003 (after TcB). RESULTS: Between August 2002 and December 2003, 8974 newborns (both vaginal and cesarean births) were admitted to the newborn nursery. Babies who did not fit the diagnosis-related group criteria of "normal newborn" were removed, leaving 6933 babies who were included in the study. April was considered a transition month and was not included in the study, leaving 6603 newborns to be included. Of these, 446 (6.8%) required phototherapy for treatment of hyperbilirubinemia before initial discharge. For the 8 months before and 8 months after initiation of TcB testing, the number of laboratory bilirubin measurements ordered per newborn did not change, nor did the mean (SD) length of stay for normal newborns [2.15 (1.1) days vs 2.12 (1.1) days; P = 0.53], nor days of treatment with phototherapy before discharge [2.9 (1.3) days vs 2.9 (1.3) days; P = 0.67]. By contrast, the number of readmissions per 1000 newborns per month for clinically significant hyperbilirubinemia decreased significantly (Wilcoxon rank-sums two-sample test, P = 0.044), from 4.5 (2.4) to 1.8 (1.7) after TcB testing was initiated. CONCLUSION: Access to TcB testing is associated with a reduction in the hospital readmission rate for hyperbilirubinemia within 7 days of the initial discharge.     

s—NSE对早期判断新生儿急性胆红素脑病的意义

目的探讨血清神经元特异性烯醇化酶（s—NSE）能否作为早期判断急性胆红素脑病（ABE）的生物学指标。方法选择高胆红素血症病儿63例,以24例同期出生的生理性黄疸不明显的足月新生儿作为对照组,测定两组血清总胆红素（TSB）水平,采用电化学发光免疫法测定s—NSE水平。结果不同高胆红素水平的各组sNSE水平比较差异有统计学意义（F=59．813,P〈0．01）,足月儿s—NSE水平与TSB水平间呈显著正相关（r=0．762,P〈0．01）;早产儿组s—NSE水平显著高于同等高胆红素水平的足月儿组（F=56．287,q=2．84,P〈0．05）。结论高胆红素血症病儿sNSE水平显著升高,升高程度与TSB水平和早产因素相关。s—NSE较TSB更有可能成为敏感的判断ABE的生物学指标。     

Supporting Breastfeeding to Reduce Newborn Readmissions for Hyperbilirubinemia

Lack of breastfeeding support can result in inadequate feedings at the breast, putting newborns at risk for hyperbilirubinemia, severe jaundice and possible hospital readmission. Nurses can help prevent readmissions for hyperbilirubinemia by becoming educated about the risk factors for hyperbilirubinemia and by implementing preventive measures through improved breastfeeding support.     

Clinical impact of transcutaneous bilirubinometry as an adjunctive screen for hyperbilirubinemia

Objective: To determine what the clinical impact would be of implementing a jaundice meter for use in a busy neonatal service as an adjunctive screening tool for hyperbilirubinemia.

Design and Methods: Test utilization data was collected for a 6-month period to determine how neonatal bilirubin was utilized in this hospital. The jaundice meter was evaluated in a study population of healthy term infants. The performance characteristics of the meter and the test utilization data were used to predict the clinical impact a meter could have on screening for hyperbilirubinemia.

Results: Utilization data indicated that about 60% of all single bilirubin neonatal testing (i.e., bilirubin only ordered) was done by normal nurseries. A jaundice meter cutoff decision reading of 17 was shown to have a sensitivity of 100% and a specificity of 68% for hyperbilirubinemia ( > 260 μmol/L) in a study population of healthy term infants. From this data, it was estimated that use of a jaundice meter could eliminate 43% of the single (i.e., not combined with other tests) bilirubin tests done on healthy term neonates with no prior exposure to phototherapy. This constitutes an overall 20% reduction in bilirubin testing in normal nurseries when testing done on babies exposed to phototherapy and combined bilirubin testing are taken into consideration. Additionally, it was shown that there would be an improvement of 9% in the prediction of hyperbilirubinemia without loss of 100% sensitivity.

Conclusion: Use of a jaundice meter in normal nurseries as an adjunctive screening tool enhances patient care by reducing the overall blood procurement rate in normal nurseries by 20% and increasing screening efficiency for significant hyperbilirubinemia by 5%.     

早期护理干预对新生儿高胆红素血症的影响

目的探讨早期护理干预对新生儿高胆红素血症的影响。方法便利抽样法选取2010年1月1日至2011年12月31日在台州市中心医院出生的7105例足月新生儿为研究对象。按其出生时间分为对照组(n=3482)和观察组(n=3623)。对照组按传统方法护理新生儿,即实行母婴同室。观察组则在传统护理基础上,采用规范健康新生儿早期的喂养、睡眠、穿衣等早期护理干预措施。比较两组新生儿出生1～5d内,经皮测黄疸指数和新生儿体质量下降指数。统计出生12个月内,两组新生儿中高胆红素血症住院率。结果日龄2～5d,两组新生儿黄疸指数和生理性体重下降的差异均有统计学意义(P<0.01)。观察组和对照组均有12例新生儿因新生儿高胆红素血症而住院,住院率分别为(8.17±4.59)%、(13.67±3.82)%,差异有统计学意义(t=-3.2,P<0.01)。结论实行早期护理干预能有效地降低健康新生儿高胆红素血症的发生,降低新生儿住院率。     

早期护理干预对新生儿黄疸及体重的影响

目的 研究早期干预对新生儿黄疸及体重的影响,防止新生儿高胆红素血症的发生.方法 将健康足月新生儿320例随机分为干预组和对照组,干预组新生儿给予早期干预(早期喂养,母乳充足前按需添加配方奶.进行游泳和抚触),对照组仅给予新生儿常规护理.记录两组新生儿胎便初排时间,胎便转黄时间.每口测量新生儿体重,经皮测胆红素值.结果 干预组经皮胆红素值明显低于对照组,差异有统计学意义(P<0.01),干预组新生儿第5天体重明显高于对照组,两组比较差异有统计学意义(P<0.01).结论 示早期护理干预能有效降低胆红素值,减少新生儿高胆红素血症的发生率,还可减少新生儿体重下降,增加出院体重.     

Hyperbilirubinemia in term and near-term infants: Kernicterus on the rise?

Jaundice in term and near-term (35 to 37 week) infants is generally benign, however, concern has surfaced in recent years regarding reemergence of kernicterus in this patient population. An increasing number of litigation cases centering on kernicterus have arisen and increasingly apparent is the fact that otherwise healthy newborn infants may be at risk for this potentially devastating neurologic condition. The purpose of this article is to provide a review on hyperbilirubinemia in term and near-term infants. Historical perspective, brief review of bilirubin physiology, and etiologies of hyperbilirubinemia will be followed by a discussion of physiologic effects/clinical symptoms of elevated serum bilirubin levels, kernicterus, and potential sequale. Methods for evaluation, treatment, and prevention of significant hyperbilirubinemia will be included.