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浙江大学学报(医学版)  2020, Vol. 49 Issue (5): 651-655    DOI: 10.3785/j.issn.1008-9292.2020.08.08
数字技术     
新生儿溶血症患者居家黄疸监测远程随访研究
徐春彩(),包盈颖(),朱佳骏*(),滕燕萍,何源远,程柯,纪凤娟,吴明远
浙江大学医学院附属妇产科医院新生儿科, 浙江 杭州 310006
Remote monitoring of neonatal jaundice in newborns with ABO hemolytic disease
XU Chuncai(),BAO Yingying(),ZHU Jiajun*(),TENG Yanping,HE Yuanyuan,CHENG Ke,JI Fengjuan,WU Mingyuan
Department of Neonatology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China
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摘要:

目的: 分析新生儿溶血症患者出院后采取居家黄疸监测方法进行远程随访的可行性。方法: 2020年1月20日至2月29日浙江大学医学院附属妇产科医院新生儿科收治的胎龄35周及以上、血清学检查确诊新生儿溶血症且实现黄疸远程随访患者为观察组(46例),2018年同期采取门诊随访的新生儿溶血症患者作为对照组(56例)。观察组患儿出院后居家应用经皮黄疸仪监测黄疸情况,利用手机开展远程随访。分析两组患儿住院期间相关资料以及出院后随访资料(包括是否再次门诊检查、是否再入院、入院时血清总胆红素水平等)。结果: 两组患儿出生胎龄、出生体质量、分娩方式、性别等一般情况差异均无统计学意义(均P>0.05)。两组患儿因高胆红素血症首次住院天数、首次血清总胆红素水平、出院时血清总胆红素水平、首次入院期间采取的治疗措施差异均无统计学意义(均P>0.05)。观察组和对照组门诊随访次数分别为(1.3±0.8)次和(3.8±0.5)次,差异有统计学意义(P < 0.01)。观察组和对照组再入院率分别为17.4%(8/46)和12.5%(7/56),差异无统计学意义(P>0.05);再入院时平均体质量分别为(3398±452)g和(3477±324)g,差异无统计学意义(P>0.05);再入院时血清总胆红素水平分别为(265±16)μmol/L和(295±15)μmol/L,差异有统计学意义(P < 0.01);患儿均未发生急性胆红素脑病。结论: 疫情期间采用居家黄疸监测和远程随访方式可减少患儿及监护人的不必要外出,且不增加患儿再入院率和发生高胆红素血症的风险。

关键词: 黄疸, 新生儿胆红素监测随访研究远程医学    
Abstract:

Objective: To explore the feasibility of remote monitoring of neonatal jaundice in newborns with ABO hemolytic disease. Methods: Forty six neonates of gestational age >35 weeks with ABO hemolytic disease admitted to Women's Hospital, Zhejiang University School of Medicine from January 20th, 2020 to February 29th, 2020 were enrolled in the study (study group). The newborns were followed up at home after discharge, the transcutaneous bilirubin (TCB) levels were measured by parents using the provided device and the results were sent to the doctor by smart phone using the installed APP. Fifty six newborns with ABO hemolytic disease admitted in 2018 who received conventional outpatient follow-up after discharge served as the control group. The demographic characteristics, total serum bilirubin (TSB) level during hospitalization, number of outpatient visit and rate of re-admission due to rebound hyperbilirubinemia were compared between the two groups. Results: There were no significant differences between the two groups in gestational age, birth weight, delivery mode, gender, length of the first hospitalization, TSB level before phototherapy and before discharge, and the managements during the first hospitalization (all P>0.05). Compared with the control group, TSB level before readmission [(265±16) μmol/L vs. (295±15) μmol/L] and the number of outpatient visits (1.3±0.8 vs. 3.8±0.5) were significantly lower in the study group (all P < 0.01), while the rate of readmission (17.4%vs. 12.5%) and the weight at the time of readmission[(3398±452) g vs. (3477±324) g] were not significantly different (all P>0.05). No cases of acute bilirubin encephalopathy occurred in both groups. Conclusion: The remote follow-up for neonatal jaundice at home can effectively reduce the number of outpatient visits without increasing the risk of readmission and severe neonatal hyperbilirubinemia for newborns with ABO hemolytic disease.

Key words: Jaundice, neonatal    Bilirubin    Monitoring    Follow-up studies    Telemedicine
收稿日期: 2020-03-16 出版日期: 2020-11-19
:  R722.18  
基金资助: 国家卫生健康委科学研究基金-浙江省医药卫生重大科技计划(WKJ-ZJ-2032)
通讯作者: 朱佳骏     E-mail: xuchuncai0329@163.com;zjuyolanda@163.com;jiajunzhu@zju.edu.cn
作者简介: 徐春彩(1987-), 女, 硕士, 主治医师, 主要从事新生儿高胆红素血症相关研究; E-mail:xuchuncai0329@163.com; https://orcid.org/0000-0001-7846-8218|包盈颖(1981-), 女, 硕士, 主治医师, 主要从事新生儿高胆红素血症相关研究; E-mail:zjuyolanda@163.com; https://orcid.org/0000-0001-5496-5877
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引用本文:

徐春彩,包盈颖,朱佳骏,滕燕萍,何源远,程柯,纪凤娟,吴明远. 新生儿溶血症患者居家黄疸监测远程随访研究[J]. 浙江大学学报(医学版), 2020, 49(5): 651-655.

XU Chuncai,BAO Yingying,ZHU Jiajun,TENG Yanping,HE Yuanyuan,CHENG Ke,JI Fengjuan,WU Mingyuan. Remote monitoring of neonatal jaundice in newborns with ABO hemolytic disease. J Zhejiang Univ (Med Sci), 2020, 49(5): 651-655.

链接本文:

http://www.zjujournals.com/med/CN/10.3785/j.issn.1008-9292.2020.08.08        http://www.zjujournals.com/med/CN/Y2020/V49/I5/651

组别 n 胎龄(周) 出生体质量(g) 男性 剖宫产 巨大儿 试管婴儿 双胎儿 低出生
体重儿
母亲妊娠期间并发症
糖尿病 高血压 宫腔感染 肝内胆汁淤积
“—”:无相关数据.
观察组 46 39.2±1.2 3264±442 16(34.8) 17(37.0) 3(6.5) 3(6.5) 2(4.3) 2(4.3) 10(21.7) 2(4.3) 2(4.3) 1(2.2)
对照组 56 39.1±1.2 3329±438 20(35.7) 16(28.6) 2(3.6) 0(0.0) 2(3.6) 1(1.8) 16(28.6) 1(1.8) 0(0.0) 1(1.8)
t/χ2 0.604 -0.749 0.010 0.811 0.051 1.825 0.000 0.030 0.621 0.030 0.737 0.000
P >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05
表 1  观察组与对照组一般情况及母亲妊娠期间并发症比较
组别 n 首次住院
天数(d)
首次入院血清总胆红素
水平(μmol/L)
出院时血清总胆红素
水平(μmol/L)
首次光疗
日龄(d)
纯母乳
喂养*
2 d内体质量
下降5%及以上
换血治疗 丙种球蛋白应用 白蛋白应用 头皮血肿 低血糖 贫血
“—”:无相关数据.*不包括首次入院时喂养方式.
观察组 46 6.0±1.9 231±58 155±32 2.3±1.1 33(71.7) 26(56.5) 1(2.2) 1(2.2) 0(0.0) 2(4.3) 0(0.0) 5(10.9)
对照组 56 6.5±1.9 230±61 149±35 2.6±1.3 38(67.9) 31(55.4) 0(0.0) 0(0.0) 2(3.6) 0(0.0) 1(1.8) 8(14.3)
t/χ2 -1.404 0.078 0.869 -1.120 0.180 0.014 0.010 0.010 0.333 0.737 0.000 0.265
P >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05
表 2  观察组与对照组黄疸相关情况及合并症比较
1 ELHAWARY I M , ABDEL GHANY E , ABOELHAMED W A et al. Incidence and risk factors of post-phototherapy neonatal rebound hyperbilirubinemia[J]. World J Pediatr, 2018, 14 (4): 350- 356
doi: 10.1007/s12519-018-0119-9
2 SHEN K , YANG Y , WANG T et al. Diagnosis, treatment, and prevention of 2019 novel coronavirus infection in children:experts' consensus statement[J]. World J Pediatr, 2020, 16 (3): 223- 231
doi: 10.1007/s12519-020-00343-7
3 VAN ROSSUM H H , DE KRAA N , THOMAS M et al. Comparison of the direct antiglobulin test and the eluate technique for diagnosing haemolytic disease of the newborn[J]. Pract Lab Med, 2015, 3 17- 22
doi: 10.1016/j.plabm.2015.10.001
4 MA X L , CHEN Z , ZHU J J et al. Management strategies of neonatal jaundice during the coronavirus disease 2019 outbreak[J]. World J Pediatr, 2020, 16 (3): 247- 250
doi: 10.1007/s12519-020-00347-3
5 杜立中 . 新生儿高胆红素血症[M]. 北京: 人民卫生出版社, 2015: 60- 68
DU Lizhong . Neonatal hyperbilirubinemia[M]. Beijing: People's Medical Publishing House, 2015: 60- 68
6 THIELEMANS L , TRIP-HOVING M , LANDIER J et al. Indirect neonatal hyperbilirubinemia in hospitalized neonates on the Thai-Myanmar border:a review of neonatal medical records from 2009 to 2014[J]. BMC Pediatr, 2018, 18 (1): 190
doi: 10.1186/s12887-018-1165-0
7 CHANG P W, NEWMAN T B. A simpler prediction rule for rebound hyperbilirubinemia[J/OL]. Pediatrics, 2019, 144(1): e20183712. DOI: 10.1542/peds.2018-3712.
8 MUNKHOLM S B, KRØGHOLT T, EBBESEN F, et al. The smartphone camera as a potential method for transcutaneous bilirubin measurement[J/OL]. PLoS One, 2018, 13(6): e0197938.DOI: 10.1371/journal.pone.0197938.
9 AFANETTI M , ELENI DIT TROLLI S , YOUSEF N et al. Transcutaneous bilirubinometry is not influenced by term or skin color in neonates[J]. Early Hum Dev, 2014, 90 (8): 417- 420
doi: 10.1016/j.earlhumdev.2014.05.009
10 TAYLOR J A , STOUT J W , DE GREEF L et al. Use of a smartphone app to assess neonatal jaundice[J]. Pediatrics, 2017, 140 (3):
doi: 10.1542/peds.2017-0312
11 DAYER L , HELDENBRAND S , ANDERSON P et al. Smartphone medication adherence apps:potential benefits to patients and providers[J]. J Am Pharm Assoc (2003), 2013, 53 (2): 172- 181
doi: 10.1331/JAPhA.2013.12202
12 容志惠, 罗芳, 马丽亚 et al. 基于智能手机应用软件拍照监测对新生儿高胆红素血症随访的意义[J]. 中华儿科杂志, 2016, 54 (8): 597- 600
RONG Zhihui , LUO Fang , MA Liya et al. Evaluation of an automatic image-based screening technique for neonatal hyperbilirubinemia[J]. Chinese Journal of Pediatrics, 2016, 54 (8): 597- 600
doi: 10.3760/cma.j.issn.0578-1310.2016.08.008
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