新生儿高胆红素血症风险矩阵的建立和作用

A combined quantified risk matrix model for predicting infant hyperbilirubinemia

摘要:

目的利用新生儿小时胆红素曲线结合临床风险因素评分，建立联合风险量化矩阵模型，预测贵州省新生儿高胆红素血症的发生风险。方法选取该院产科出生的5 250 例足月儿和近足月儿，连续记录其出生后168 h的经皮胆红素（TCB）值。将出生后72 h内对应的危险区TCB测定值作为预测指标，建立联合风险量化矩阵。结果使用二次方程对TCB 曲线进行二次曲线拟合，结果显示，TCB 水平在24～48 h内上升速率最快，而后逐渐降低。单因素分析结果显示，胎龄、分娩方式、胎膜早破及喂养方式与72 h后TCB 高危险区有关。多因素结果显示，72 h后TCB 高危险区与出生体重、分娩方式、胎膜早破及喂养方式有关联。胎龄为36.01～39.99周的研究对象处于72 h后高危险区的可能性是胎龄≥40.00周研究对象的1.73 倍；剖宫产出生的新生儿与顺产比较，处于高危险区的可能性可降低51%；与混合人工喂养相比，人工喂养的研究对象处于高危险区的可能性较大[OR=2.173（95%CI：1.267，3.683）]。建立联合风险量化矩阵模型，分 12 个区。通过释然比水平高低，将12 个区组分为4 个风险水平，用以预测新生儿高胆红素的发生可能性。结论基于联合风险量化矩阵和新生儿小时胆红素百分位数曲线，将新生儿分为4 个风险水平，可对新生儿TCB水平变化开展精准随访，有效预防新生儿黄疸的发生。

Abstract:

Objective To predict infant hyperbilirubinemia intuitively, effectively and accurately with a combined quantified risk matrix built by infant hour-specific transcutaneous bilirubin (TCB) and the score system of clinical risk factors. Methods In total, 5,250 healthy term and near-term newborns (gestational age ≥35 weeks, birth weight ≥2,000 g) from Guizhou Provincial Hospital of Maternal and Child Health Care were included and their TCB values were continuously recorded in 168 hours after birth. The TCB values in the risk zones were used as the predictors. The hour-specific TCB nomograms were applied to establish a combined quantified risk matrix model with clinical risk factors. Results The conic curve fitting the TCB nomograms with the quadratic equation showed that the TCB level increased fastest in 24-48 h, subsequently decreased. The univariate analysis showed that the infants in high risk zone after 72 h were associated with gestational age (GA), delivery mode, premature rupture of membranes (PROM) and feeding patterns. The multivariate analysis showed that the infants in high risk zone after 72 h were correlated with birth weight,delivery mode, PROM and feeding patterns. The likelihood of the participants with GA of 36.01-39.99 w in the high risk zone after 72 h was 1.73 times that of the infants with GA of 40.00 w. Comparing to the infants by vaginal delivery, those by cesarean section were 51% less likely to be in high risk zone after 72 h.The infants with artificial feeding were more likely to be in high risk zone after 72 h compared to those with mixed feeding [OR = 2.173, 95% CI (1.267, 3.683) ]. A combined quantified matrix model was built by TCB risk zones and four clinical risk levels, which had 12 blocks. The 12 blocks were grouped into 4 risk levels,namely very high (VH), high (H), median (M) and low (L) to predict the likelihood of hyperbilirubinemia. Conclusions Based on the combined quantified matrix model and hour-specific TCB nomograms, infants are assigned into four risk levels to facilitate the implementation of accurate interview and prevent neonatal jaundice effectively.