背景/目的:胆汁淤积的罕见原因之一可能是胎儿和新生儿溶血病(HDFN)。方法:我们回顾性分析了88例HDFN新生儿胆汁淤积的病历和186例无胆汁淤积的HDFN患儿的病历,并进行了观察,病例控制,回顾性研究。结果:影响胆汁淤积风险的因素是出生胎龄较低(36.83±1.9vs.37.57±1.8,p=0.002),Rh或KiddHDFN(80.7%与53.2%),和需要宫内输血(27.3vs.11.8%)。受试者出生时血红蛋白浓度较低(14.01±3.8vs.16.39±2.8g/dL)和整个住院期间,脐带血总胆红素浓度(4.26±1.8vs.2.39±1.4mg/dL),较高的最大胆红素浓度(15.27±5.8vs.10.24±3.4mg/dL),和更频繁的肝脏超声异常(19.9vs.6.3%)。由于产后输血率较高,他们还需要更长时间的住院(33vs.3.8%),更频繁地需要交换输血(8.8%vs.2.2%),更长时间和更高的光疗风险(94.3vs.59.1%),和更高的免疫球蛋白使用率(55.7vs.8.1%),肠外营养(45.5vs.12.9%),和抗生素(14.8vs.4.8%)。结论:HDFN患儿发生胆汁淤积的危险因素是分娩时胎龄较低,HDFN的Rh和Kidd血清学类型,需要宫内输血.
Background/Objectives: One of the rare causes of cholestasis may be hemolytic disease of the fetus and newborn (
HDFN). Methods: We retrospectively analyzed 88 medical records of
HDFN newborns with cholestasis and 186 records of children with
HDFN without cholestasis and conducted an observational,
case-control, retrospective study. Results: Factors influencing the risk of cholestasis were lower gestational age at birth (36.83 ± 1.9 vs. 37.57 ± 1.8, p = 0.002), Rh or Kidd
HDFN (80.7% vs. 53.2%), and the need for intrauterine transfusion (27.3 vs. 11.8%). The subjects had lower hemoglobin concentrations at birth (14.01 ± 3.8 vs. 16.39 ± 2.8 g/dL) and during whole hospital stay, higher cord blood total bilirubin concentration (4.26 ± 1.8 vs. 2.39 ± 1.4 mg/dL), higher maximum bilirubin concentration (15.27 ± 5.8 vs. 10.24 ± 3.4 mg/dL), and more frequent liver ultrasound abnormalities (19.9 vs. 6.3%). They also required more extended hospitalization due to higher rates of postnatal blood transfusion (33 vs. 3.8%), more frequent need for exchange transfusion (8.8% vs. 2.2%), more extended time and higher risk of phototherapy (94.3 vs. 59.1%), and higher usage of immunoglobulins (55.7 vs. 8.1%), parenteral nutrition (45.5 vs. 12.9%), and antibiotics (14.8 vs. 4.8%). Conclusions: The risk factors for cholestasis in children with HDFN are lower gestational age at delivery, Rh and Kidd serological type of
HDFN, and the need for intrauterine transfusions.