- 期刊
Etiological Factors and Clinical Aspects of Chinese Neonatal Hyperbilirubinemia
中國新生兒高膽紅素血症之病因及臨床觀察
摘要
高膽紅素血症是新生兒常見的疾病，其病因的分佈情形常因地理與人種之不同而有異；本報告探討中國新生兒高膽紅素血症之病因，並分析其臨床表徵及治療經過。 臺北市立仁愛醫院小兒科自民國67年1月至69年12月間，因新生兒高膽紅素血症（血清膽紅素值大於15mg%）而住院的，有196位嬰兒，其中ABO母子血型不台（母親血型為O，嬰兒為A或B）、紅血球G-6-PD缺乏、低出生體重或其混合者是常見的病因，但仍有27%無法確定其病因。 ABO血型不合佔29%，有54%的嬰兒於出生後24小時內出現黃疸，而大多數的嬰兒在第2、3天因黃疸遞增而住院、約有三分之一的嬰兒其血比容值小於50%，二分之一其網織血球大於2.5%，有45位接受光線療法，12位接受換血。 G-6-PD缺乏者佔18%，其中男性佔94%，黃疸於第2、3天出現，而在第3至11天住院，住院時的平均血清膽紅素值較其他組為高，多數病嬰有貧血或網織血球增多的現象，18位接受光線療法，17位接受換血，有3位死亡。 低出生體重者佔13%，黃疸於第2、3天出現，而於第3至6天接受治療，少見貧血，但有一半的嬰兒其網織血球大於2.5%, 20位接受光線療法，共平均膽紅素下降值較小，而接受治療的時閒較長，5位接受換血。 無法確定病因者佔27%，除了較高的膽紅素值外，其黃疸的出現及其遞增的情形與「生理性」黃疸大致相同，47位接受光線療法，6位接受換血。
關鍵字
無資料並列摘要
Possible etiological factors and clinical aspects of neonatal hyperbilirubinemia were studied in 196 Chinese newborn infants from 1978 to 1980. Neonates with ABO fetomaternal incompatibility (29.1%), erythrocyte G-6-PD deficiency (17.9%), low birth weight (12.7%), and no associated cause (27.0%) comprised the majority of cases. Early onset of jaundice with rapid increase in serum bilirubin level was the characteristic feature of ABO incompatibility; mild anemia and reticulocytosis were found, but direct Coombs test was usually negative. Most of the G-6-PD deficient newborns were male; jaundice appeared on the second or third day of life, but the peak serum bilirubin level was reached between the third and eleventh day of life and was more severe than that of the others. Anemia and reticulocytosis suggested the nature of hemolysis but no offending agents could be found. The jaundice of low birth weight newborns appeared on the second or third day and reached the peaks in the succeeding four days. Apart from high serum bilirubin, levels, the clinical Pictures and laboratory findings of the no associated cause group were similar to those of ”physiologic” jaundice, Phototherapy was effective but caution should be taken in the management of jaundice due to ABO incompatibility and G-6-PD deficiency, and especially the latter. Exchange transfusion was found effective and safe.