尼泊尔南部新生儿黄疸的发生率及危险因素。
Incidence of and risk factors for neonatal jaundice among newborns in southern Nepal.
机构信息
Department of International Health, Global Disease Epidemiology and Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
出版信息
Trop Med Int Health. 2013 Nov;18(11):1317-28. doi: 10.1111/tmi.12189. Epub 2013 Sep 23.
OBJECTIVE
To quantify the incidence of and risk factors for neonatal jaundice among infants referred for care from a rural, low-resource, population-based cohort in southern Nepal.
METHODS
Study participants were 18,985 newborn infants born in Sarlahi District in southern Nepal from May 2003 through January 2006 who participated in a cluster-randomised, placebo-controlled, community-based trial to evaluate the effect of newborn chlorhexidine cleansing on neonatal mortality and morbidity. Jaundice was assessed based on visual assessment of the infant by a study worker and referral for care. Adjusted relative risks (RR) were estimated to identify risk factors for referral for neonatal jaundice using Poisson regression.
RESULTS
The incidence of referral for neonatal jaundice was 29.3 per 1000 live births (95% confidence interval: 26.9, 31.7). Male sex, high birth weight, breastfeeding patterns, warm air temperature, primiparity, skilled birth attendance, place of delivery, prolonged labour, oil massage, paternal education and ethnicity were significant risk factors (P-values < 0.01). After multivariable adjustment, sex, birth weight, difficulty feeding, prolonged labour, primiparity, oil massage, ambient air temperature and ethnicity remained important factors. Among infants with difficulty feeding, exclusive breastfeeding was a risk factor for neonatal jaundice, whereas exclusive breastfeeding was protective among infants with no report of difficulty feeding.
CONCLUSIONS
Several known risk factors for neonatal jaundice in a low-resource setting were confirmed in this study. Unique observed associations of jaundice with ambient air temperature and oil massage may be explained by the opportunity for phototherapy based on the cultural practices of this study population. Future research should investigate the role of an infant's difficulty in feeding as a potential modifier in the association between exclusive breastfeeding and jaundice.
目的
量化在尼泊尔南部一个农村、资源匮乏、基于人群的队列中，转诊接受治疗的婴儿的新生儿黄疸发生率和危险因素。
方法
本研究的参与者是 18985 名 2003 年 5 月至 2006 年 1 月期间在尼泊尔南部的萨拉希区出生的新生儿，他们参加了一项以群组为基础的、随机对照、基于社区的试验，以评估对新生儿进行洗必泰清洁对新生儿死亡率和发病率的影响。黄疸是通过研究工作者对婴儿的视觉评估和转诊进行评估的。使用泊松回归估计调整后的相对风险（RR），以确定新生儿黄疸转诊的危险因素。
结果
转诊新生儿黄疸的发生率为 29.3/1000 活产儿（95%置信区间：26.9，31.7）。男婴、高出生体重、母乳喂养模式、暖空气温度、初产妇、熟练接生、分娩地点、产程延长、油按摩、父亲教育和种族是显著的危险因素（P 值<0.01）。经过多变量调整后，性别、出生体重、喂养困难、产程延长、初产妇、油按摩、环境空气温度和种族仍然是重要的因素。在有喂养困难的婴儿中，纯母乳喂养是新生儿黄疸的危险因素，而在没有报告喂养困难的婴儿中，纯母乳喂养是保护因素。
结论
本研究证实了一些在资源匮乏环境中新生儿黄疸的已知危险因素。在这种文化习俗下，黄疸与环境空气温度和油按摩之间的独特关联可能与光疗机会有关。未来的研究应调查婴儿喂养困难作为纯母乳喂养与黄疸之间关联的潜在修饰因子的作用。
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