Drozdowska-Szymczak Agnieszka, Mazanowska Natalia, Pomianek Tomasz, Ludwin Artur, Krajewski Paweł
Department of Neonatology and Neonatal Intensive Care, Institute of Mother and Child, Kasprzaka 17a, 01-211 Warsaw, Poland.
Department of Obstetrics and Gynecology, Institute of Mother and Child, Kasprzaka 17a, 01-211 Warsaw, Poland.
J Clin Med. 2024 May 29;13(11):3190. doi: 10.3390/jcm13113190.
: One of the rare causes of cholestasis may be hemolytic disease of the fetus and newborn (HDFN). : We retrospectively analyzed 88 medical records of HDFN newborns with cholestasis and 186 records of children with HDFN without cholestasis and conducted an observational, case-control, retrospective study. : Factors influencing the risk of cholestasis were lower gestational age at birth (36.83 ± 1.9 vs. 37.57 ± 1.8, = 0.002), Rh or Kidd HDFN (80.7% vs. 53.2%), and the need for intrauterine transfusion (27.3 vs. 11.8%). The subjects had lower hemoglobin concentrations at birth (14.01 ± 3.8 vs. 16.39 ± 2.8 g/dL) and during whole hospital stay, higher cord blood total bilirubin concentration (4.26 ± 1.8 vs. 2.39 ± 1.4 mg/dL), higher maximum bilirubin concentration (15.27 ± 5.8 vs. 10.24 ± 3.4 mg/dL), and more frequent liver ultrasound abnormalities (19.9 vs. 6.3%). They also required more extended hospitalization due to higher rates of postnatal blood transfusion (33 vs. 3.8%), more frequent need for exchange transfusion (8.8% vs. 2.2%), more extended time and higher risk of phototherapy (94.3 vs. 59.1%), and higher usage of immunoglobulins (55.7 vs. 8.1%), parenteral nutrition (45.5 vs. 12.9%), and antibiotics (14.8 vs. 4.8%). : The risk factors for cholestasis in children with HDFN are lower gestational age at delivery, Rh and Kidd serological type of HDFN, and the need for intrauterine transfusions.
胎儿和新生儿溶血病（HDFN）可能是胆汁淤积症的罕见病因之一。我们回顾性分析了88例患有胆汁淤积症的HDFN新生儿的病历以及186例无胆汁淤积症的HDFN儿童的病历，并进行了一项观察性、病例对照、回顾性研究。影响胆汁淤积风险的因素包括出生时孕周较小（36.83±1.9 vs. 37.57±1.8，P = 0.002）、Rh或基德HDFN（80.7% vs. 53.2%）以及宫内输血需求（27.3 vs. 11.8）。研究对象出生时血红蛋白浓度较低（14.01±3.8 vs. 16.39±2.8 g/dL）且在整个住院期间均较低，脐血总胆红素浓度较高（4.26±1.8 vs. 2.39±1.4 mg/dL），最高胆红素浓度较高（15.27±5.8 vs. 10.24±3.4 mg/dL），肝脏超声异常更为频繁（19.9% vs. 6.3%）。由于产后输血率较高（33% vs. 3.8%）、换血需求更频繁（8.8% vs. 2.2%）、光疗时间更长且风险更高（94.3% vs. 59.1%）以及免疫球蛋白（55.7% vs. 8.1%）、肠外营养（45.5% vs. 12.9%）和抗生素（14.8% vs. 4.8%）的使用量更高，他们还需要更长时间的住院治疗。HDFN儿童胆汁淤积症的危险因素包括分娩时孕周较小、HDFN的Rh和基德血清学类型以及宫内输血需求。
