儿科医师进驻产科查房对新生儿黄疸管理的意义
|
摘要
目的探讨儿科医师进驻产科查房,规范实施新生儿黄疸管理指南对新生儿高胆红素血症转归的临床影响。方法研究对象为出生健康的足月儿和晚期早产儿,分为管理组(3 785例)和对照组(4 131例),2组新生儿性别、出生体重、胎龄比较差异无统计学意义。监测经皮胆红素和血清总胆红素值。回顾性观察2组新生儿高胆红素血症的发生率、门诊高胆红素血症再入院率、入院时血清总胆红素值、符合换血标准比率、高胆红素血症门诊随访率等指标。结果①新生儿高胆红素血症的发生率:管理组16.2%,对照组15.6%,2组差异无统计学意义(χ~2=0.551,P=0.446);②门诊高胆红素血症再入院率:管理组35.5%,高于对照组的29.3%(χ~2=5.534,P=0.024);③血清总胆红素值:管理组为(299.0±27.6)μmol/L,对照组为(303.0±31.9)μmol/L,管理组血清总胆红素值低于对照组(t=2.380,P=0.022);④符合换血标准比率:管理组为2.1%,对照组为4.0%,管理组低于对照组(χ~2=3.891,P=0.047);⑤新生儿黄疸的门诊随访率:管理组(82.7%)显著高于对照组(54.6%);⑥新生儿黄疸相关因素:围产期因素38.4%、早发母乳性黄疸23.6%、感染10.6%、溶血9.1%、头皮血肿4.5%。结论儿科医师进驻产科查房,通过对产科新生儿高胆红素血症全程、规范管理并进行适时干预,有效随访,可减少严重的高胆红素血症发生。
Objective To explore the clinical impact of pediatricians in obstetric ward rounds and standardize the implementation of neonatal jaundice management guidelines for neonatal hyperbilirubinemia. Methods The healthy, full-term infants or late preterm infants form April 2017 to April 2018 were selected and divided into management group(n=3 785) and control group(n=4 131). There was no significant difference in gender, birth weight and gestational age between the two groups. Transcutaneous bilirubin(TcB) and total serum bilirubin monitoring were performed. The incidence of hyperbilirubinemia, rate of rehospitalization of outpatient, serum total bilirubin at admission, rate of compliance with transfusion guidelines, and outpatient follow-up rate were retrospectively reviewed. Results ①The incidence of neonatal hyperbilirubinemia was 16.2% in the management group and 15.6% in the control group, with no statistically significant(χ~2=0.551, P=0.446). ②The rate of rehospitalization of outpatient with hyperbilirubinemia was 35.5% in the management group, which was higher than 29.3% in the control group(χ~2=5.534, P=0.024). ③ The level of serum total bilirubin was(299.0±27.6) μmol/L in the management group, which was lower than(303.0±31.9) μmol/L in the control group(t=2.380, P=0.022). ④ The rate meeting the standard of blood transfusion was 2.1% in the management group, which was lower than 4.0% in the control group(χ~2=3.891, P=0.047). ⑤ The neonatal jaundice outpatient follow-up rate was 82.7% in the management group, which was significantly higher than 54.6% in the control group. ⑥ The risk factors for neonatal jaundice included perinatal factor(38.4%), early breast milk jaundice(23.6%), infection(10.6%), hemolysis(9.1%) and scalp hematoma(4.5%). Conclusion Pediatrician admission to obstetrics wards rounds can standardize and intervene the management of neonatal jaundice in the Department of Obstetrics and avoid severe hyperbilirubinemia by effective follow-up.
Objective To explore the clinical impact of pediatricians in obstetric ward rounds and standardize the implementation of neonatal jaundice management guidelines for neonatal hyperbilirubinemia. Methods The healthy, full-term infants or late preterm infants form April 2017 to April 2018 were selected and divided into management group(n=3 785) and control group(n=4 131). There was no significant difference in gender, birth weight and gestational age between the two groups. Transcutaneous bilirubin(TcB) and total serum bilirubin monitoring were performed. The incidence of hyperbilirubinemia, rate of rehospitalization of outpatient, serum total bilirubin at admission, rate of compliance with transfusion guidelines, and outpatient follow-up rate were retrospectively reviewed. Results ①The incidence of neonatal hyperbilirubinemia was 16.2% in the management group and 15.6% in the control group, with no statistically significant(χ~2=0.551, P=0.446). ②The rate of rehospitalization of outpatient with hyperbilirubinemia was 35.5% in the management group, which was higher than 29.3% in the control group(χ~2=5.534, P=0.024). ③ The level of serum total bilirubin was(299.0±27.6) μmol/L in the management group, which was lower than(303.0±31.9) μmol/L in the control group(t=2.380, P=0.022). ④ The rate meeting the standard of blood transfusion was 2.1% in the management group, which was lower than 4.0% in the control group(χ~2=3.891, P=0.047). ⑤ The neonatal jaundice outpatient follow-up rate was 82.7% in the management group, which was significantly higher than 54.6% in the control group. ⑥ The risk factors for neonatal jaundice included perinatal factor(38.4%), early breast milk jaundice(23.6%), infection(10.6%), hemolysis(9.1%) and scalp hematoma(4.5%). Conclusion Pediatrician admission to obstetrics wards rounds can standardize and intervene the management of neonatal jaundice in the Department of Obstetrics and avoid severe hyperbilirubinemia by effective follow-up.
引文
[1] AL-LAWAMA M,AL-RIMAWI E,AL-SHIBI R,et al.Adoption of the American Academy of Pediatrics’ neonatal hyperbilirubinemia guidelines and its effect on blood exchange transfusion rate in a tertiary care center in Amman,Jordan[J].J Blood Med,2018,9:61-66.
[2] SGRO M,KANDASAMY S,SHAH V,et al.Severe Neonatal Hyperbilirubinemia Decreased after the 2007 Canadian Guidelines[J].J Pediatr,2016,171:43-47.
[3] 中华医学会儿科学分会新生儿学组,中国新生儿胆红素脑病研究协作组.中国新生儿胆红素脑病的多中心流行病学调查研究[J].中华儿科杂志,2012,50(5):331-335.
[4] SLUSHER T M,VREMAN H J,OLUSANYA B O,et al.Safety and efficacy of filtered sunlight in treatment of jaundice in African neonates[J].Pediatrics,2014,133(6):e1568-1574.
[5] JOHNSON L,BHUTANI V K,KARP K,et al.Clinical report from the pilot USA Kernicterus Registry(1992 to 2004)[J].J Perinatol,2009,29 Suppl l:S25-45.
[6] YU Z,HAN S,WU J,et al.Validation of transcutaneous bilirubin nomogram for identifying neonatal hyperbilirubinemia in healthy Chinese term and late-preterm infants:a multicenter study[J].J Pediatr(Rio J),2014,90(3):273-278.
[7] American Academy of Pediatrics Subcommittee on Hyperbilirubinemia.Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation[J].Pediatrics,2004,114(1):297-316.
[8] WALDROP J B,ANDERSON C K,BRANDON D H.Guideline-based educational intervention to decrease the risk for readmission of newborns with severe hyperbilirubinemia[J].J Pediatr Health Care,2013,27(1):41-50.
[9] 中华医学会儿科学分会新生儿学组,《中华儿科杂志》编辑委员会.新生儿高胆红素血症诊断和治疗专家共识[J].中华儿科杂志,2014,52(10):745-748.
[10] MOHAMED I,BLANCHARD A C,DELVIN E,et al.Plotting transcutaneous bilirubin measurements on specific transcutaneous nomogram results in better prediction of significant hyperbilirubinemia in healthy term and near-term newborns:a polot study[J].Neonatology,2014,105(4):306-311.
[11] OLUSANYA B O,OSIBANJO F B,SLUSHER T M,et al.Risk factors for severe neonatal hyperbilirubinemia in low and middle-income countries:a systematic review and meta-analysis[J].PLoS One,2015,10(2):e0117229.
[12] MITRA S,RENNIE J.Neonatal jaundice:aetiology,diagnosis and treatment[J].Br J Hosp Med(Lond),2017,78(12):699-704.
[13] CHANG R J,CHOU H C,CHANG Y H,et al.Weight loss percentage prediction of subsequent neonatal hyperbilirubinemia in exclusively breastfed neonates[J].Pediatr Neonatol,2012,53(1):41-44.
[14] MUCHOWSKI K E.Evaluation and treatment of neonatal hyperbilirubinemia[J].Am Fam Physician,2014,89(11):873-878.
[15] 石碧珍,陈兰,韩树萍,等.健康新生儿经皮小时胆红素百分位列线图预测高胆红素血症的价值[J].中国当代儿科杂志,2016,18(3):201-205.
[16] HAN S,YU Z,LIU L,et al.A model for predicting significant hyperbilirubinemia in neonates from China[J].Pediatrics,2015,136(4):e896-905.
[17] SCRAFFORD C G,MULLANY L C,KATZ J,et al.Incidence of and risk factors for neonatal jaundice among newborns in southern Nepal[J].Trop Med Int Health,2013,18(11):1317-1328.
[18] BHARDWAJ K,LOCKE T,BIRINGER A,et al.Newborn Bilirubin Screening for Preventing Severe Hyperbilirubinemia and Bilirubin Encephalopathy:A Rapid Review[J].Curr Pediatr Rev,2017,13(1):67-90.
[19] MATEO P C,LEE K S,BAROZZINO M,et al.Management of neonatal jaundice varies by practitioner type[J].Can Fam Physician,2013,59(8):e379-386.
[2] SGRO M,KANDASAMY S,SHAH V,et al.Severe Neonatal Hyperbilirubinemia Decreased after the 2007 Canadian Guidelines[J].J Pediatr,2016,171:43-47.
[3] 中华医学会儿科学分会新生儿学组,中国新生儿胆红素脑病研究协作组.中国新生儿胆红素脑病的多中心流行病学调查研究[J].中华儿科杂志,2012,50(5):331-335.
[4] SLUSHER T M,VREMAN H J,OLUSANYA B O,et al.Safety and efficacy of filtered sunlight in treatment of jaundice in African neonates[J].Pediatrics,2014,133(6):e1568-1574.
[5] JOHNSON L,BHUTANI V K,KARP K,et al.Clinical report from the pilot USA Kernicterus Registry(1992 to 2004)[J].J Perinatol,2009,29 Suppl l:S25-45.
[6] YU Z,HAN S,WU J,et al.Validation of transcutaneous bilirubin nomogram for identifying neonatal hyperbilirubinemia in healthy Chinese term and late-preterm infants:a multicenter study[J].J Pediatr(Rio J),2014,90(3):273-278.
[7] American Academy of Pediatrics Subcommittee on Hyperbilirubinemia.Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation[J].Pediatrics,2004,114(1):297-316.
[8] WALDROP J B,ANDERSON C K,BRANDON D H.Guideline-based educational intervention to decrease the risk for readmission of newborns with severe hyperbilirubinemia[J].J Pediatr Health Care,2013,27(1):41-50.
[9] 中华医学会儿科学分会新生儿学组,《中华儿科杂志》编辑委员会.新生儿高胆红素血症诊断和治疗专家共识[J].中华儿科杂志,2014,52(10):745-748.
[10] MOHAMED I,BLANCHARD A C,DELVIN E,et al.Plotting transcutaneous bilirubin measurements on specific transcutaneous nomogram results in better prediction of significant hyperbilirubinemia in healthy term and near-term newborns:a polot study[J].Neonatology,2014,105(4):306-311.
[11] OLUSANYA B O,OSIBANJO F B,SLUSHER T M,et al.Risk factors for severe neonatal hyperbilirubinemia in low and middle-income countries:a systematic review and meta-analysis[J].PLoS One,2015,10(2):e0117229.
[12] MITRA S,RENNIE J.Neonatal jaundice:aetiology,diagnosis and treatment[J].Br J Hosp Med(Lond),2017,78(12):699-704.
[13] CHANG R J,CHOU H C,CHANG Y H,et al.Weight loss percentage prediction of subsequent neonatal hyperbilirubinemia in exclusively breastfed neonates[J].Pediatr Neonatol,2012,53(1):41-44.
[14] MUCHOWSKI K E.Evaluation and treatment of neonatal hyperbilirubinemia[J].Am Fam Physician,2014,89(11):873-878.
[15] 石碧珍,陈兰,韩树萍,等.健康新生儿经皮小时胆红素百分位列线图预测高胆红素血症的价值[J].中国当代儿科杂志,2016,18(3):201-205.
[16] HAN S,YU Z,LIU L,et al.A model for predicting significant hyperbilirubinemia in neonates from China[J].Pediatrics,2015,136(4):e896-905.
[17] SCRAFFORD C G,MULLANY L C,KATZ J,et al.Incidence of and risk factors for neonatal jaundice among newborns in southern Nepal[J].Trop Med Int Health,2013,18(11):1317-1328.
[18] BHARDWAJ K,LOCKE T,BIRINGER A,et al.Newborn Bilirubin Screening for Preventing Severe Hyperbilirubinemia and Bilirubin Encephalopathy:A Rapid Review[J].Curr Pediatr Rev,2017,13(1):67-90.
[19] MATEO P C,LEE K S,BAROZZINO M,et al.Management of neonatal jaundice varies by practitioner type[J].Can Fam Physician,2013,59(8):e379-386.