足月儿高胆红素血症482例相关因素分析

目的 探讨足月儿高胆红素血症(简称高胆)的相关因素以及高胆程度.方法 对2001年7月-2006年7月收治的高胆足月儿482例进行分析.结果 482例高胆患儿中,早发型母乳性黄疸178例(36.9%,其中70.3%为剖宫产),迟发型母乳性黄疸125例(25.9%),ABO血型不合溶血60例(12.5%),围产相关因素54例(11.2%),感染相关因素49例(10.2%),其他16例(3.3%).以溶血者总血清胆红素最高(351.0±188.1)μmol/L.482例高胆患儿中轻、中、重度分别占42.5%、36.3%和21.2%.重度高胆中早发型母乳性黄疸31例(30.4%),ABO溶血20例(19.6%),迟发型母乳性黄疸25例(24.5%).482例中核黄疸4例,1例为严重酸中毒、脱水,3例为ABO溶血.结论 母乳性黄疸为住院足月儿高胆的主要原因,剖宫产可能与早发型母乳性黄疸有关;ABO溶血是导致患儿核黄疸的主要原因.

Clinical analysis of neonatal hyperbilirubinemia in 482 full-term newborns

Objectives To investigate the etiologies of neonatal hyperbilirubinemia.Methods Clinical data of 482 full-term neonates with neonatal hyperbilirubinemia,admitted in Bethune International Peace Hospital from July 2001 to July 2006,were analyzed.Results Causes of hyperbilirubinemia were early-onset breastfeeding jaundice(36.9%,70.3% of them were born by caesarean section),late-onset breastfeeding jaundice(25.9%),ABO incompatibility hemolytic diseases(12.5%),perinatal risk factors(11.2%),infections(10.2%)and others(3.3%).Total bilirubin level was the highest in newborns with hemolytic disease.The percentages of mild,moderate and severe jaundice were 42.5%,36.3%,and 21.2%,respectively.Among patients with severe jaundice,20(30.4%)were with early-onset breastfeeding jaundice,20(19.6%)were with hemolytic disease,and 25(24.5%)were with late-onset breastfeeding jaundice.There were 4 patients with kernicterus included in this study(3 patients with hemolytic disease,one with severe acidosis and dehydration).Conclusions The most common cause of full-term neonatal hyperbilirubinemia in inpatients is breastfeeding jaundice.Hemolytic diseases account for the majority of kernicterus.