交换输血术对高胆红素血症新生儿血清免疫球蛋白的影响

目的 评估高胆红素血症新生儿的体液免疫状态及其进行交换输血治疗(换血术)前后的血清免疫球蛋白(Ig)水平变化情况,了解换血术对新生儿血清Ig的影响.方法 对62例高胆红素血症新生儿进行换血治疗,治疗前后分别测定其血清Ig(IgG、IgA、IgM)水平,并依据病因分成ABO溶血病组、Rh溶血病组、脓毒症组和其他组进行分析.结果 1.换血术前:ABO溶血病组、Rh溶血病组IgG水平均显著高于脓毒症组及其他组(Pa＜0.01),各组间IgA、IgM水平无明显差异(Pa>0.05).2.换血术后ABO溶血病组、Rh溶血病组IgG水平均较换血前显著下降(Pa＜0.05);其他组及脓毒症组IgG水平均较换血前升高,但差异无统计学意义(P=0.387,0.091).3.换血后4组IgA水平均较换血前升高,且其他组、ABO溶血病组和Rh溶血病组治疗前后比较差异有统计学意义(Pa=0.000),脓毒症组治疗前后无统计学意义(P=0.185).4.换血后4组IgM水平均较换血前升高,其他组、ABO溶血病组和Rh溶血病组治疗前后比较均有统计学意义(Pa＜0.05),但脓毒症组治疗前后无统计学意义(P=0.081);且其他组、ABO溶血病组和Rh溶血病组各组间治疗后比较有统计学意义(P＜0.01).结论 1.新生儿溶血病患儿术前血清IgG水平较高,换血术能迅速降低溶血病患儿血IgG水平,提升患儿血IgA、IgM水平;2.换血术对脓毒症患儿血清IgG、IgA、IgM的水平无明显影响;3.换血术能提高其他高胆红素血症患儿血清IgA、IgM水平,但对血清IgG水平无明显影响.     

不同光源对新生儿高胆红素血症的作用评价

目的　 评价不同光源的作用。 方法 　生后 49～ 72h ,血清总胆红素 >2 0 5 μmol/L之足月高胆儿 ,随机分为蓝光组、蓝绿光组及绿光组各 2 0例 ,持续光疗 48h。光强度 (单位 μw·cm2 ·nm)蓝光 12～ 16,蓝绿光 8～ 12 ,绿光 5～ 8。光疗前后分别检血细胞、血生化及内分泌激素。 结果 　与光疗前比较 ,光疗后蓝光及蓝绿光组血红细胞减少 ;三组血胆红素均显著下降 ,以蓝光组为著 ,蓝绿光组次之 ,绿光组不像文献所报导有效 ;三组对其他血细胞、血生化及内分泌激素均无影响。 结论 　除蓝光可致轻度贫血外 ,无其他副作用。但比较不同光源对降低血胆红素的疗效 ,必须要光谱纯度、光强度、半衰期等条件较一致时 ,才能作出科学的评价。     

不同光疗方法对高间接胆红素血症新生儿染色体的影响

目的探讨不同光疗方法对高间接胆红素血症新生儿染色体的影响。方法对高间接胆红素血症新生儿40例按光疗方式分为A、B组(单面蓝光组20例、单面白光组20例),分别测定光疗前、光疗1～4d外周血淋巴细胞姐妹染色单体交换(SCE)值。结果1.A组治疗4d(累积48h)后分别与光疗前、光疗1～3dSCE水平比较均有显著差异(P均<0.05),光疗3d内(累积36h内)SCE水平与光疗前比较无显著性差异(P>0.05);2.B组治疗后SCE变化较大,治疗1d(累积12h)后SCE即明显增加,与治疗前相比有显著性差异(P均<0.05)。且SCE水平随照射时间增加而显著增加;3.治疗1d后,B组SCE水平即高于A组。结论单面白光照射治疗对高间接胆红素血症新生儿染色体的影响较单面蓝光照射治疗的影响大。     

思密达治疗新生儿高胆红素血症45例

新生儿高胆红素血症是新生儿常见疾病 ,在医院设备所限无法用光疗的情况下 ,给予茵栀黄退黄及保肝等综合治疗 ,但疗效不十分满意。思密达用于治疗新生儿母乳性黄疸文献中已有报道[1] 。我们用思密达口服辅助治疗新生儿高胆红素血症 ,疗效满意 ,现报告如下。资料与方法一、对象　 1999年 3月～ 2 0 0 2年 12月我院收治的 4 5例新生儿高胆红素血症 ,日龄均 <2 8d ,均符合病理性黄疸诊断标准[2 ] 。总胆红素 <342 .0 μmol/L(2 0mg/dl) ,未成熟儿总胆红素 <2 5 6 .5 μmol/L(15mg/dl)。感染性黄疸 14例 ,头颅血肿 8例 ,母乳性黄疸 13例 ,溶血…     

非洲新生儿高胆红素血症316例

本文总结了厄立特里亚国首都儿科医院新生儿科 1997年 1月～ 2 0 0 1年 12月高胆红素血症 (高胆 )患儿 316例的病因及临床特点 ,现报道如下。临床资料一、一般资料　对象均来自厄立特里亚国首都儿科医院新生儿科。均符合以下诊断标准[1] :足月儿血清胆红素 >2 0 5 .2 μmol/L ,早产儿 >2 5 6 .5 μmol/L。男 2 2 1例 ,女 95例 ;足月儿 2 16例 ,早产儿 80例 ,过期产儿 2 0例 ;日龄在 7d内(早期高胆 ) 2 30例 ,大于 7d(延迟高胆 ) 86例。延迟高胆以母乳性黄疸占第 1位 ,其次围生和感染因素。二、病因及高胆程度　见表 1。 5例Rh溶血病黄疸程…     

新生儿高胆红素血症的防治

新生儿黄疸是新生儿期最常见症状,尤其是早期(生后1周内)新生儿更多见。由于新生儿胆红素代谢的特点,约有5 0 %足月儿和80 %早产儿可出现肉眼可见黄疸,一般足月儿血清胆红素浓度不超过2 0 5 μmol/L(12mg/dl) ,早产儿胆红素不超过2 5 6 μmol/L(15mg/dl) ,称为生理性黄疸。在此     

新生儿高胆红素血症外周动静脉同步换血疗法--附26例报告

目的探讨高胆红素血症外周动静脉同步换血的可行性及疗效。方法外周静脉输血,速度150ml／h,外周动脉抽血,采用留置针头,速度参照输血速度,血源选择与患儿同型血。多功能监护仪监测生命体征,记录有关参数。换血前后行血常规、生化、肝功能、血培养等检查。结果总胆红素由换血前471．81μmol／L下降至换血后254．38μmol／L,换出率是46．08％。平均换血量140ml／kg。换血后除白细胞、血小板、K     

新生儿高胆红素血症的高危因素

目的了解产科高危因素对新生儿高胆红素血症(HB)发病情况的影响,为早期防治HB提供依据。方法回顾性调查2004年1月～2006年12月本院产科出生并因病转入儿科住院治疗新生儿HB542例,其中明确新生儿科疾病299例(55.17%),出生前有产科因素320例(59.04%;部分病例同时有明确新生儿科疾病),未明病因76例(14.02%)。排除有明确新生儿科疾病后,余192例HB列为统计分析对象,采用Logistic多因素回归分析围生期产科相关危险因素。结果胎膜早破、宫内窘迫、羊水粪染、高龄初产、剖宫产、生后体质量明显下降、母乳缺乏、肝内胆管淤积症、妊娠期高血压、胎龄及母亲产前使用催产素、镇静剂是新生儿高胆红素血症的主要危险因素。结论加强围生期管理,积极处理孕期疾病,严格掌握剖宫产指征,减少人为催产比例,加强高危妊娠、高危分娩监测,积极喂养是有效地控制HB发生的重要因素。     

121例新生儿高胆红素血症临床分析

黄疸是新生儿期最常见的症状之一,且此症在逐年增加。严重患儿若不及时治疗则易造成神经系统的损害。本将我院儿科近3年新生儿高胆红素血症住院患儿121例进行分析,报告如下。     

新生儿重症高胆红素血症临床危险因素分析

目的 探讨引起新生儿重症高胆红素血症的临床危险因素.方法 2007年8月至2008年4月期间于本院新生儿内科病房住院的重症高胆红素血症患儿,研究组入选标准:出生14d之内,血清胆红素峰值达342 μmol/L以上,以非结合胆红素增高为主,非结合胆红素占总胆红素的80%以上的患儿.设立对照组,入选标准:足月和早产儿生后14 d之内血清胆红素峰值分别>220.6 μmol/L和256.5 μmol/,L,<342 μmol/L.排除标准:患儿乙肝表面抗原阳性或其他由于肝性疾病引起的黄疸.应用Logistic回归模型,对临床常见的病因如感染、窒息、头颅血肿、早产、ABO或Rh溶血,遗传代谢病及病因不明进行回顾性分析.结果 研究组有79例,对照组有96例.感染是引起新生儿高胆红素血症的最常见原因,其次是原因不明,早产,溶血,窒息,头颅血肿,遗传代谢病.应用IJogistic回归分析显示,研究组与对照组对比,只有早产及原因不明两组因素差异存在统计学意义.结论 新生儿高胆红素血症的病因发生了明显的变迁,临床原因不明的新生儿重症高胆红素血症将是未来研究的重点.     

200例新生儿高间接胆红素血症的临床分析

新生儿高间接胆红素血症（以下简称高胆）发病率较高,在部分医院依然占据新生儿住院病例的首位［１～４］。为进一步了解新生儿高胆的病因、程度分布、发病日龄、临床主要表现、治疗所需时间和预后等相互间关系,本文对我院儿科住院的２００例新生儿高胆患儿的临床资料作...     

Risk factors for severe hyperbilirubinemia in neonates

The incidence of severe neonatal hyperbilirubinemia is higher in Asians than in whites. A case-control study was designed to investigate the effects of eight known risk factors [breast feeding, ABO incompatibility, premature birth, infection, cephalohematoma, asphyxia, glucose-6-phosphate dehydrogenase (G6PD) deficiency, and variant UDP-glucuronosyltransferase 1A1 (UGT1A1) gene] and a suspicious analog [organic anion transporter 2 (OATP 2) gene] on severe hyperbilirubinemia in Taiwanese neonates. The 72 study subjects and 100 hospital control subjects consisted of neonates with peak serum bilirubin levels > or =342 microM and <256.5 microM, respectively. The PCR-restriction fragment length polymorphism method was applied to detect the UGT1A1, OATP 2, and G6PD genes. The results of multivariate logistic regressions, adjusted for covariates, revealed odds ratios (ORs) of 4.64 [95% confidence interval (CI): 2.25-9.57; p < 0.001], 3.36 (95% CI: 1.54-7.35; p=0.002), and 3.02 (95% CI: 1.30-6.99; p=0.010) for neonates who were fed with breast milk, and carry the variant UGT1A1 gene at nucleotide 211 and the variant OATP 2 gene at nucleotide 388, respectively. The ORs, adjusted for covariates, for the other six risk factors were not statistically significant. The ORs in neonates who had one, two, and three significant risk factors were 8.46 (95% CI: 2.75-34.48; p < 0.001), 22.0 (95% CI: 5.50-88.0; p < 0.001), and 88.0 (95% CI: 12.50-642.50; p < 0.001), respectively. In conclusion, neonates who carry the 211 and 388 variants in the UGT1A1 and OATP 2 genes, respectively, as well as feed with breast milk are at high risk to develop severe hyperbilirubinemia.     

新生儿高胆红素血症尿微量蛋白的测定

高胆红素血症是新生儿常见疾病,其对中枢神经系统的损害已被广泛认识和重视,但对肾功能的影响国内外报道较少。为了探讨新生儿高胆红素血症对肾功能的影响,我们对35例高胆红素血症的足月新生儿进行了尿4种微量蛋白的测定,现报道如下。     

Genetic polymorphisms in Thai neonates with hyperbilirubinemia

Aim:  Polymorphisms of the UGT1A1 gene, SLCO1B1 gene and GST gene have been associated with significant hyperbilirubinemia. We would like to determine whether the variation of UGT1A1 gene, SLCO1B1 gene and GST gene may play a significant role in neonatal hyperbilirubinemia in Thai infants.
Methods:  Ninety-one study subjects (hyperbilirubinemic group) and 86 control subjects were studied.
Results:  The cause of neonatal hyperbilirubinemia could not be identified in 64 infants (70.3%), ABO blood group incompatibility in 14.3% and Glucose-6-phosphate dehydrogenase (G-6-PD) deficiency in 8.8%. In the hyperbilirubinemic group, 23 of 91 (25.3%) infants demonstrated variant of UGT1A1 at nucleotides (nt) 211 as compared to 6 of 86 (7%) in the control group (p = 0.001). There were no significant differences between groups in the variants UGT1A1 at nt 686, SLCO1B1 gene at nt 388, 463 and the GST gene. Male infants with G-6-PD deficiency were associated with hyperbilirubinemia (21.2% vs. 4.8% in the control group) with an odds ratio (OR) of 5.37 (p =0.02). The relationship between G-6-PD and variant in UGT1A1 gene at nt 211 could not be determined.
Conclusion:  Thai infants with variant in the UGT1A1 at nt 211 or with G-6-PD deficiency are at higher risk for developing neonatal hyperbilirubinemia.     

外周动静脉全自动同步换血治疗新生儿重症高胆红素血症20例临床观察

目的 评价小于两倍血容量的外周动静脉全自动同步换血治疗新生儿重症高胆红索血症的效果及相关影响因素.方法 对20例高胆红素血症患儿采用外周动静脉同步换血,换血前及换血后同一动脉采血进行血清总胆红素、血糖、血气、电解质(K+、Na+、Ca2+)监测.结果 换血后血清总胆红素较换血前明显降低,换血后平均胆红素下降率为29.92%,换血前后相比较K+、Ca2+有明显下降(分别为P＜0.05和P＜0.01),血清总胆红素显著下降(P＜0.01),Na+、血糖、pH值无显著差异(P＞0.05),血红蛋白明显上升(P＜0.05).按换血时间将患儿分为＜3 h与≥3 h两组进行比较,结果≥3 h组胆红素较＜3 h组明显下降,两组比较差异有显著性(P＜0.05).结论 小于两倍血容量换血对内环境影响相对较小,外周动静脉全自动同步换血安全性高,控制换血时间(≥3 h)可得到较高效率.     

新生儿高胆红素血症听觉诱发电位检测的临床意义

目的　 通过对新生儿高胆红素血症患儿进行脑干听觉诱发电位 (BAEP)检测 ,评估高胆红素血症在未发生核黄疸时对脑损害及听力的影响。 方法 　对新生儿高胆红素血症患儿入院后进行脑干听觉诱发电位的测定。 结果 　 49例高胆红素血症患儿中异常BAEP发生率为 3 7%( 18/ 49例 ) ,表现为各波潜伏期 (PL)及波间潜伏期 (IPL)的延长和听阈值的增高 ,听阈值随胆红素浓度的增高而增高 ,经治疗后黄疸消退 ,脑干听觉诱发电位大部分恢复正常。 结论 　高胆红素血症对新生儿可造成听力损害 ,BAEP是检测高胆红素血症患儿听力筛查的重要手段之一     

Transcutaneous bilirubin in predicting hyperbilirubinemia in term neonates

Objective  To assess the utility of 24 and 48 hours transcutaneous bilirubin (TcB) index for predicting subsequent significant hyperbilirubinemia in healthy term neonates. Methods  TcB indices were obtained for healthy, breastfed, term AGA newborns at 24 ± 2, 48 ± 2 and subsequently at intervals of 24 hours. Neonates with illness, on treatment and positive Direct Coomb’s test were excluded. Serum bilirubin levels were obtained whenever indicated. Neonates having serum bilirubin ≥ 17 mg/dL were considered as significant hyperbilirubinemia. The 24 and 48 hour TcB indices, as risk predictors for such hyperbilirubinemia were determined. Results  Study included 461 healthy term neonates. The mean birth weight was 2949 (± 390) gm and mean gestation of 38.6 (± 1.1) weeks. Eight one (17.6%) had significant hyperbilirubinemia. Of 461, 135 (29.3%) had TcB index < 5 at 24 hours and 200 (43.3%) had index < 8 at 48 hours. None of them had later hyperbilirubinemia (100 % negative predictive value). Significant hyperbilirubinemia increased from 8.1 % to 76.4% as 24 hours TcB index raised from 5 to 9 and from 10.4 % to 83.7% as 48 hour TcB index raised from 8 to 11. Sensitivity and specificity were optimised at TcB value of 7(risk: OR=26.8, 95%Cl: 13.9–51.5) at 24 hours and 10 (risk: OR= 17.1, 95%Cl 8.9–32.9) at 48 hours. C-statistics for 24 and 48 hour measurements are 0.838 and 0.836 respectively. Conclusion  The 24 and 48 hour TcB indices are predictive for subsequent significant hyperbilirubinemia and can guide clinician in early discharge of healthy term newborns.     

新生儿高胆红素血症对远期预后的影响

目的探讨新生儿血清胆红素水平及其对远期预后的影响。方法 对120例新生儿高胆红素血症患儿在5-10岁时进行智力、听力及神经系统随访。结果31例有智力缺陷,其中9例干预治疗后恢复正常;25例听力损失;5倒有神经系统改变,其中脑性瘫痪3例,单侧肢体(左上肢)运动障碍、语言障碍各1例。智力、听力及神经系统异常率与血清总胆红素峰值均无显著相关(P均>0.05)溶血组与非溶血组异常率无显著差异(P>0.05)结论除重度高胆红素血症外,轻中度高胆红素血症也可对新生儿产生神经损害,致神经精神发育异常,仅凭血清总胆红素水平并不能确切判断远期预后 对所有高胆红素血症新生儿均应积极治疗,尽量减少后遗症