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目的探讨新生儿胆红素脑病的病因及临床特点。方法选择2006年1月至2010年1月我院新生儿科收治的重症新生儿高胆红素血症患儿,分为胆红素脑病组(脑病组)与非胆红素脑病组(非脑病组),比较两组患儿病因、临床特征、胆红素水平、胆红素/白蛋白比值(B/A)以及治疗转归。结果脑病组黄疸病因以溶血性因素占首位(48.5%),其次是感染因素(24.2%);非脑病组黄疸病因主要为溶血(69.7%)。脑病组总胆红素、B/A比值、入院日龄和黄疸持续时间均大于非脑病组[(555.2±113.9)μmol/L比(431.3±62.3)μmol/L,(0.87±0.17)比(0.67±0.11),(129.5±60.7)h比(53.0±22.6)h,(81.6±39.6)h比(34.2±15.8)h,P均<0.001]。胆红素脑病警告期与痉挛期患儿入院日龄、血清胆红素及B/A比值差异无统计学意义(P>0.05)。85%的胆红素脑病患儿预后不良。结论溶血与感染是新生儿胆红素脑病的主要原因,总胆红素浓度过高和干预延迟是引起胆红素脑病的高危因素。
Objective To investigate the etiology and clinical features of neonatal bilirubin encephalopathy. Methods From January 2006 to January 2010, infants with severe neonatal hyperbilirubinemia admitted to neonatology department of our hospital were divided into two groups: bilirubin encephalopathy group (encephalopathy group) and non-bilirubin encephalopathy group (non-encephalopathy Group). Etiology, clinical features, bilirubin level, Bilirubin / albumin ratio (B / A) and treatment outcome were compared between the two groups. Results The etiology of jaundice in encephalopathy group was mainly hemolytic (48.5%), followed by infection (24.2%). The etiology of jaundice in non-encephalopathy group was hemolysis (69.7%). The total bilirubin, B / A ratio, duration of admission and jaundice in encephalopathy group were higher than those in non-encephalopathy group (555.2 ± 113.9 μmol / L vs 431.3 ± 62.3 μmol / L, 0.87 ± 0.17 vs 0.67 ± 0.11), (129.5 ± 60.7) h vs (53.0 ± 22.6) h, (81.6 ± 39.6) h vs (34.2 ± 15.8) h, respectively, P <0.001]. There was no significant difference in the bilirubin and B / A ratio between the bilirubin encephalopathy warning group and the convulsive group on admission date (P> 0.05). 85% of children with bilirubin encephalopathy have a poor prognosis. Conclusion Hemolysis and infection are the main causes of neonatal bilirubin encephalopathy. The high total bilirubin concentration and delayed intervention are the risk factors of bilirubin encephalopathy.