Singla Deeksha A, Sharma Seema, Sharma Milap, Chaudhary Sanjeev
Department of Pediatrics, Dr. Rajendra Prasad Government Medical College, Tanda, Himachal Pradesh, India.
Int J Appl Basic Med Res. 2017 Oct-Dec;7(4):228-232. doi: 10.4103/ijabmr.IJABMR_298_16.
Neonatal hyperbilirubinemia continues to be the most common cause of hospital admissions and readmissions in the neonatal population worldwide and this pattern continues despite attempts to identify neonates at risk of pathological hyperbilirubinemia. Therefore, this study aimed to study the risk factors for severe hyperbilirubinemia in neonates.
An observational prospective study was undertaken for 1 year in neonates with hyperbilirubinemia requiring double volume exchange transfusion in neonatology unit of a tertiary rural health care hospital.
Risk factors included ABO incompatibility in 14 (28.5%), Rh incompatibility in 14 (28%). Other risk factors for hyperbilirubinemia were, jaundice in elder sibling, oxytocin use, birth asphyxia, hypothyroidism, ABO along with Rh incompatibility, Glucose-6 phosphate Dehydrogenase deficiency, cephalhematoma, and sepsis in neonates. Ten (20%) neonates were neurologically abnormal with signs of encephalopathy. Significant association of risk factors with neurotoxicity were also found. All neurologically abnormal neonates were small for date and none was appropriate for date ( = 0.05). There were no neurologically abnormal neonates with A+ and O- mothers ( = 0.04).
The high rate of exchange transfusion warrants aggressive management of neonatal hyperbilirubinemia by health-care providers by adequate dissemination of information, strict following of hour-based normograms, performing total serum bilirubin assessment in all icteric neonates, and stratification into risk groups thereafter.
新生儿高胆红素血症仍是全球新生儿住院和再次入院的最常见原因，尽管已尝试识别有病理性高胆红素血症风险的新生儿，但这种情况仍持续存在。因此，本研究旨在探讨新生儿重度高胆红素血症的危险因素。
在一家三级农村医疗保健医院的新生儿科，对需要进行双倍量换血治疗的高胆红素血症新生儿进行了为期1年的前瞻性观察研究。
危险因素包括ABO血型不合14例（28.5%），Rh血型不合14例（28%）。其他高胆红素血症的危险因素有年长同胞有黄疸、使用缩宫素、出生窒息、甲状腺功能减退、ABO血型与Rh血型均不合、葡萄糖-6磷酸脱氢酶缺乏、头颅血肿以及新生儿败血症。10例（20%）新生儿有神经系统异常，伴有脑病体征。还发现危险因素与神经毒性之间存在显著关联。所有神经系统异常的新生儿均小于胎龄，无适于胎龄儿（P = 0.05）。母亲血型为A+和O-的新生儿中无神经系统异常者（P = 0.04）。
高换血率要求医疗保健人员积极管理新生儿高胆红素血症，充分传播信息，严格遵循基于小时的标准曲线，对所有黄疸新生儿进行总血清胆红素评估，并随后将其分为危险组。
