上海交通大学学报（医学版）

上海交通大学学报（医学版） ›› 2017, Vol. 37 ›› Issue (10): 1383-.doi: 10.3969/j.issn.1674-8115.2017.10.015

• 论著（临床研究） • 上一篇    下一篇

新生儿重度高胆红素血症与听力损伤的相关性研究#br#

盛王涛，方旭华，李菁，孙建华，贝斐，张国庆   

  1. 上海交通大学 医学院附属上海儿童医学中心新生儿科，上海 200127
  • 出版日期:2017-10-28 发布日期:2017-11-01
  • 通讯作者: ?方旭华，电子信箱：2249296885@qq.com
  • 作者简介:盛王涛（1991—），男，住院医师，硕士；电子信箱：470974044@qq.com

Correlation of severe neonatal hyperbilirubinemia and hearing damage

SHENG Wang-tao, FANG Xu-hua, LI Jing, SUN Jian-hua, BEI Fei, ZHANG Guo-qing   

  1. Department of Neonatology, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
  • Online:2017-10-28 Published:2017-11-01

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摘要： 目的 · 探讨重度高胆红素血症患儿听力损伤相关高危因素和随访预后。方法 · 对 2015 年 6 月至2016 年 6 月上海儿童医学中 心新生儿科收治的106 例重度高胆红素血症患儿，按照胆红素水平分为3 组：重度高胆红素血症组[ 血清总胆红素（TSB）峰值大于 342.0 μmol/L 且小于 427.5 μmol/L]、极重度高胆红素血症组（TSB 峰值范围 427.5 ～ 513.0 μmol/L）、危险性高胆红素血症组（TSB 峰值 大于 513.0 μmol/L）。在出院前用自动脑干听觉诱发电位（AABR）进行听力筛查，对筛查未通过的患儿于 3 月龄时进行诊断性脑干听 觉诱发电位（ABR）检查，并对所有患儿（3 月龄和 6 月龄）随访听性行为反应观察状况。结果 · 3 组患儿共 106 例，出院前 AABR 筛 查未通过 33 例（33/106, 31.13%），其中重度高胆红素血症组未通过 22 例（22/86，25.58%），极重度高胆红素血症组未通过 9 例（9/16， 56.25%），危险性高胆红素血症组未通过 2 例（2/4，50.00%），各组之间差异有统计学意义（均 P<0.05）。通过专人负责定期宣教，出 院前 AABR 筛查未通过的 33 例患儿全都于 3 月龄时来院接受诊断性 ABR 检查，结果 2 例患儿被诊断为轻度听力损伤，但其中 1 例考 虑为中耳炎所致。同时，全部106 例重度高胆红素血症患儿完成3 月龄和 6 月龄听性行为反应观察，结果状况良好。结论 · 重度高胆 红素血症是新生儿听力损伤的高危因素之一，TSB 水平越高，听力损伤也越明显。重度高胆红素血症引起的听力损伤可能可逆，但也 提示听力随访计划有待完善。重度高胆红素血症造成的听力损伤可能对患儿日常生活无明显影响，仍需对患儿进行长期随访。

关键词: 新生儿重度高胆红素血症, 听力损伤, 高危因素, 随访

Abstract:

 Objective · To investigate the risk factors of hearing damage in child patients with severe neonatal hyperbilirubinemia (NHB) and follow up their prognosis.  Methods · Clinical data of 106 newborns with severe NHB in neonatal ward of Shanghai Children’s Medical Center from June 2015 to June 2016 were retrospectively analyzed. According to total serum bilirubin (TSB) level, they were divided into three groups, severe NHB group (342.0 μmol/L<TSB peak <427.5 μmol/L), very severe NHB group (TSB peak range 427.5-513.0 μmol/L), and fatal NHB group (TSB peak > 513.0 μmol/L). Automatic auditory brainstem response (AABR) was used to evaluate the hearing ability of children in hospital, while those who got abnormal results would undergo diagnostic test of auditory brainstem response (ABR) when 3 months old. Auditory behavioral response of all 106 child patients at 3 and 6 months old were followed up.  Results · There were totally 106 cases in three groups, among which 33 cases (33/106, 31.13%) got abnormal results at hearing screening in hospital, 22 cases (22/86, 25.58%) in severe NHB group, 9 cases (9/16, 56.25%) in very severe NHB group, and 2 cases (2/4, 50.00%) in fatal NHB group. The difference between groups was statistically significant (all P<0.05). All 33 patients not passing AABR in hospital came to undergo diagnostic test of ABR through regular education by a specially assigned person when 3 months old. Two children were diagnosed mild hearing damage. One of them was considered being caused by tympanitis. All children had good situation of auditory behavioral response at 3 and 6 months old in follow-up.  Conclusion · Severe NHB is one of the high risk factors of hearing damage in neonates. The morbidity of hearing damage was higher with the increase of TSB level. The hearing damage caused by severe NHB might be reversible. It also suggested that the follow-up plan should be improved. The hearing damage caused by severe NHB might have no obvious effect on children in daily life, but long term follow-up of these children is still needed.

Key words: severe neonatal hyperbilirubinemia, hearing damage, risk factors, follow-up