CAJ | 학술논문

目的通过收集全国较大范围内母乳喂养新生儿生理性黄疸的调查资料，得出我国新生儿黄疸胆红素的峰值和平均值，为临床诊断奠定基础。方法采取统一课题设计、多中心协作的方法，对875例足月新生儿自生后第1天（24小时内）开始每天监测胆红素水平直至血清胆红素峰值达68.4 μmol/L以下。对其中56例血清胆红素峰值大于220.5 μmol/L者做脑干听力诱发电位的测定。结果（1）足月新生儿出生后第2-3天开始出现黄疸，第5天达高峰，平均峰值为204±54.69 μmol/L。血清胆红素峰值超过220.5 μmol/L者占34.4％。（2）不同地区（P<0.01）及不同季节(P<0.05)出生的新生儿其血清胆红素值差异有显著性。（3）在围产因素中，新生儿早期的胆红素水平与胎龄(P<0.01)、分娩方式(P<0.01)、出生后1-3天的生理性体重下降(P<0.001)及红细胞压积水平(P<0.001)密切相关。结论足月新生儿黄疸出现的时间与国内外其他报道相似，但平均峰值高于既往报道的局部人群的峰值，更明显高于西方国家的新生儿。血清胆红素峰值超过220.5 μmol/L者占34.4％。56例血清胆红素超过220.5 μmol/L的足月新生儿的脑干听力诱发电位无异常发现。提示新生儿高胆红素血症的诊断标准应高于现行标准,因而高胆红素血症的干预标准也应相应提高。
목적 통과수집전국교대범위내모유위양신생인생이성황달적조사자료，득출아국신생인황달담홍소적봉치화평균치，위림상진단전정기출。방법 채취통일과제설계、다중심협작적방법，대875례족월신생인자생후제1천（24소시내）개시매천감측담홍소수평직지혈청담홍소봉치체68.4 μmol/L이하。대기중56례혈청담홍소봉치대우220.5 μmol/L자주뇌간은력유발전위적측정。 결과 （1）족월신생인출생후제2-3천개시출현황달，제5천체고봉，평균봉치위204±54.69 μmol/L。혈청담홍소봉치초과220.5 μmol/L자점34.4％。（2）불동지구（P<0.01）급불동계절(P<0.05)출생적신생인기혈청담홍소치차이유현저성。（3）재위산인소중，신생인조기적담홍소수평여태령(P<0.01)、분면방식(P<0.01)、출생후1-3천적생이성체중하강(P<0.001)급홍세포압적수평(P<0.001)밀절상관。 결론 족월신생인황달출현적시간여국내외기타보도상사，단평균봉치고우기왕보도적국부인군적봉치，경명현고우서방국가적신생인。혈청담홍소봉치초과220.5 μmol/L자점34.4％。56례혈청담홍소초과220.5 μmol/L적족월신생인적뇌간은력유발전위무이상발현。제시신생인고담홍소혈증적진단표준응고우현행표준,인이고담홍소혈증적간예표준야응상응제고。
Objective To provide epidemiological data for revising thediagnostic criteria of neonatal hyperbilirubinemia in China. Methods A survey was performed among full-term infants in multiple centers throughout the country. From less than 24 hours after birth, the infants' bilirubin levels were measured every day until the peak level fell to less than 68.4 μmol/L. Auditory brainstem responses were assessed in 56 infants randomly chosen from those with serum bilirubin levels of higher than 220.5 μmol/L. Results Jaundice in most infants was detected at 2-3 days after birth. The bilirubin level usually reached a peak level of 204±54.69 μmol/L at 5 days after birth and then fell. Among the 875 infants, the serum bilirubin levels in 34.4% of neonates were higher than 220.5 μmol/L. The mean serum bilirubin level of the infants during the first week after birth varied with geography (P<0.001) and season (P<0.001). The serum bilirubin level was significantly associated with gestation age (P<0.01), delivery method (P<0.01), weight loss (P<0.001), and PCV elevation (P<0.001) during the first three days after birth. Conclusions The start time of neonatal jaundice was similar to that reported elsewhere, but the mean peak level in our study was higher than the reported. It is suggested that the diagnostic criteria for neonatal hyperbilirubinemia in China should be strict.