探讨晚期早产儿高胆红素血症的发病情况及围生期管理。

选取2013年10月至2015年3月，于四川大学华西第二医院新生儿科住院治疗的276例晚期早产儿中，被诊断为高胆红素血症的35例晚期早产儿为研究对象，纳入研究组；再采取等距抽样方法，从其余241例非高胆红素血症的晚期早产儿中，选取35例纳入对照组。采用回顾性分析方法，收集2组患儿的一般临床资料，并逐一对以下项目进行分析：①采用χ²检验或Fisher确切概率法，对2组患儿的性别、出生胎龄、入院日龄、入院途径、适于胎龄(AGA)儿、小于胎龄(SGA)儿、大于胎龄(LGA)儿、分娩方式构成比，以及胎膜早破、宫内或生后窒息、头颅血肿及母亲孕期疾病发生率进行比较。②了解纳入研究的276例晚期早产儿中，高胆红素血症发生率，以及高胆红素血症患儿中男、女患儿所占比例。③研究组35例晚期早产儿患儿的性别、入院日龄、入院途径、出生胎龄、AGA儿与LGA儿、分娩方式、出生医疗机构构成比，以及重度与极重度高胆红素血症发生率及伴发疾病或病因、胆红素脑病发生率、再入院率。

①研究组与对照组患儿的出生胎龄、入院日龄及途径、早产儿类型、分娩方式构成比，以及胎膜早破发生率、宫内或生后窒息发生率比较，差异均有统计学意义(χ²＝12.011，P＝0.002；χ²＝16.931，P<0.001；χ²＝31.895，P<0.001；χ²＝13.473，P＝0.001；χ²＝18.913，P<0.001；χ²＝5.927，P＝0.019；χ²＝8.454，P＝0.004)。2组患儿的性别构成比、头颅血肿发生率、母亲孕期疾病发生率比较，差异均无统计学意义(P>0.05)。②纳入研究的276例晚期早产儿中，高胆红素血症发生率为12.7%(35/276)。35例高胆红素血症晚期早产儿中，男、女性别比为1.9∶1。③研究组35例高胆红素血症晚期早产儿中，出生胎龄为34^＋0～36^＋6周，重度与极重度高胆红素血症患儿均为15例，重度和极重度高胆红素血症患儿所占比例为85.7%(30/35)，无危险性高胆红素血症发生；入院日龄≤7 d者居多，占60.0%(21/35)，此类患儿系产科母婴同室出院后由门、急诊收入新生儿科者，再入院率高达94.3%(33/35)。研究组晚期早产儿的出生医疗机构中，二级医院和三级医院所占比例相当，分别占45.7%(16/35)和48.6%(17/35)。35例高胆红素血症晚期早产儿的伴发疾病或病因中，合并严重感染患儿的占比为17.1%(6/35)、ABO血型不合溶血病为11.4%(4/35)、头颅血肿为5.7%(2/35)、葡萄糖-6-磷酸脱氢酶(G6PD)缺乏症为2.9%(1/35)，同时合并上述多种病因为5.7%(2/35)，但是仍然有57.1%(20/35)患儿未找到导致高胆红素血症发生的明确病因。研究组35例高胆红素血症晚期早产儿中，胆红素脑病发生率高，为40.0%(14/35)，换血率亦较高，为62.9%(22/35)。

高胆红素血症晚期早产儿中，重度、极重度高胆红素血症所占比例高，胆红素脑病发生率高，其中患儿为男性、入院日龄≤7 d、出生胎龄为35^＋0～35^＋6周、AGA儿、自然分娩、有伴发疾病者所占比例高。临床重视对医护人员进行新生儿高胆红素血症规范管理的培训、强化对出院新生儿黄疸监测的力度等围生期管理措施，这对降低高胆红素血症晚期早产儿的伤残，提高其生存质量具有重要意义。

To investigate the incidence of hyperbilirubinemia in late preterm newborns and their perinatal management.

From October 2013 to March 2015, a total of 35 cases of late preterm newborns who were diagnosed as hyperbilirubinemia were selected from 276 inpatient of late preterm newborns in Department of Neonatology, West China Second University Hospital, Sichuan University were included in study group, and another 35 patients who had not been diagnosed as hyperbilirubinemia were selected randomly from the other 241 inpatient cases and were included in control group by isometric sampling method. Retrospective analysis method was used to collect the clinical data of two groups and to analyze the following items. ①To compare the constituent ratios of gender, gestational age at birth, day age at the time of admission, admission ways, appropriate for gestational age (AGA) infants, small for gestational age (SGA) infants, large for gestational age (LGA) infants, delivery modes, and the incidences of premature rupture of membrane, intrauterine or postnatal asphyxia, cephalohematoma, pregnancy diseases in pregnant women between study group and control group by chi-square method or Fisher exact probability method. ②Incidence of hyperbilirubinemia among 276 cases of late preterm newborns in the study, and the relationship with the gender were analyzed. ③The constituent ratios of gender, day age at the time of admission, admission ways, gestational age at birth, AGA or LGA infants, delivery modes, birth institutions, and the incidences of severe and extremely severe highperbilirubinemia, concomitant diseases or causes of disease, bilirubin encephalopathy and readmission etc. in study group were analyzed.

①There were significant differences between two groups among the constituent ratios of gestational age at birth, day age at the time of admission, admission ways, premature types, delivery modes, and the incidences of premature rupture of membranes and intrauterine or postnatal asphyxia (χ²=12.011, P=0.002; χ²=16.931, P<0.001; χ²=31.895, P<0.001; χ²=13.473, P=0.001; χ²=18.913, P<0.001; χ²=5.927, P=0.019; χ²=8.454, P=0.004), respectively. There were no significant differences between two groups among the gender ratio, the incidences of cephalohematoma in fetuses and pregnancy diseases in pregnant women (P>0.05), respectively. ②Among the 276 cases of late preterm newborns included in the study, hyperbilirubinemia incidence was 12.7% (35/276). Gender ratio of male and female was 1.9∶1 in 35 cases of late preterm newborns diagnosed as hyperbilirubinemia. ③Among the 35 hyperbilirubinemia of late preterm newborns in study group, the gestational age at birth was 34^{+ 0}-36^{+ 6} weeks, severe and extremely severe hyperbilirubinemia both were 15 cases, which accounting for 85.7% (30/35), there was none of dangerous hyperbilirubinemia neonates. And hyperbilirubinemia of late preterm newborns whose age≤7 d was more than that of age>7 d at the time of admission, and the proportion of late preterm newborns of age≤7 d was 60.0% (21/35), after discharge from rooming-in periods, they rehospitalized from outpatient and emergency department into neonatal department, and their rehospitalized rate was 94.3% (33/35). Level of birth medical institutions of late preterm newborns in study group between grade second and grade third was 45.7% (16/35) and 48.6% (17/35), respectively. Among the accompanied diseases or causes of 35 hyperbilirubinemia of late preterm newborns in study group, infection, ABO blood group incompatible hemolytic disease, glucose-6-phosphate dehydrogenase (G6PD) deficiency, cephalohematoma and multiple causes of diseases accounted for 17.1% (6/35), 11.4% (4/35), 5.7% (2/35), 2.9% (1/35), 5.7%(2/35), respectively; but there was the other 57.1% (20/35) still could not found a clear cause of hyperbilirubinemia. The incidence of bilirubin encephalopathy of late preterm newborns in study group was as high as 40% (14/35), and blood exchange rate was also as high as 62.9% (22/35).

In late preterm newborns with hyperbilirubinemia, the rate of severe and extremely severe hyperbilirubinemia, and incidence of bilirubin encephalopathy are high. And the rates of males, age≤7 d at the time of admission, 35^{+ 0}-35^{+ 6} gestational weeks at birth, AGA infants, natural birth, complications were also high. Therefore, it is important to emphasize the training of health care workers for normative management of neonatal hyperbilirubinemia, and strengthening neonatal icterus monitoring perinatal management and other measures, so as to reduce disability and improve the life quality of late preterm newborns with hyperbilirubinemia.