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  • 王晓莉,杨琳,沈彩琴.延迟断脐对中晚期早产儿早期发生黄疸和颅内出血的影响[J].第二军医大学学报,2021,42(3):338-342    [点击复制]
  • WANG Xiao-li,YANG Lin,SHEN Cai-qin.Effects of delayed umbilical cord clamping on early jaundice and intracranial hemorrhage in moderate and late preterm infants[J].Acad J Sec Mil Med Univ,2021,42(3):338-342   [点击复制]
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延迟断脐对中晚期早产儿早期发生黄疸和颅内出血的影响
王晓莉1*,杨琳2,沈彩琴1
0
(1. 上海市嘉定区妇幼保健院新生儿科, 上海 201821;
2. 复旦大学附属儿科医院新生儿科, 上海 200032
*通信作者)
摘要:
目的 探讨延迟断脐对于中晚期早产儿早期发生黄疸和颅内出血的影响。方法 选择上海市嘉定区妇幼保健院2016年2月1日至2018年1月31日顺产的中晚期(32~36+6周)早产儿作为研究对象,其中2016年2月1日至2017年1月31日顺产的早产儿在娩出后15 s内断脐(早断脐组),2017年2月1日至2018年1月31日顺产的早产儿在娩出后待脐动脉停止搏动后断脐(延迟断脐组)。比较两组新生儿生后1 d血清总胆红素、生后1~3 d经皮胆红素、蓝光照射治疗开始时间、生后1 d和7 d血常规及颅内出血发生率。结果 符合纳入条件进入本研究的中晚期早产儿共308例,其中延迟断脐组165例,早断脐组143例。两组间早产儿及其母亲基本信息差异均无统计学意义(P>0.05)。两组早产儿生后1 d血清总胆红素水平差异无统计学意义(P>0.05);延迟断脐组生后2 d和3 d经皮胆红素水平均高于早断脐组,差异有统计学意义(P<0.05)。两组早产儿蓝光照射治疗开始时间差异无统计学意义(P>0.05)。延迟断脐组早产儿生后1 d和7 d血红蛋白水平及血细胞比容均高于早断脐组,差异有统计学意义(P<0.05);两组白细胞计数和血小板计数差异均无统计学意义(P>0.05)。两组早产儿颅内出血发生率差异无统计学意义(P>0.05)。结论 延迟断脐可提高中晚期早产儿生后早期血红蛋白水平及血细胞比容,虽可一定程度增高经皮胆红素水平但并不需要提前进行蓝光照射治疗,并且未增加颅内出血的发生率,对于中晚期早产儿是一项安全、有效的措施。
关键词:  延迟断脐  早断脐  早产儿  黄疸  血红蛋白  颅内出血
DOI:10.16781/j.0258-879x.2021.03.0338
投稿时间:2020-04-23修订日期:2020-09-27
基金项目:上海市嘉定区科学技术委员会资助项目(JDKW-2017-W25).
Effects of delayed umbilical cord clamping on early jaundice and intracranial hemorrhage in moderate and late preterm infants
WANG Xiao-li1*,YANG Lin2,SHEN Cai-qin1
(1. Department of Neonatology, Maternal and Child Health Care Hospital of Shanghai Jiading District, Shanghai 201821, China;
2. Department of Neonatology, Children's Hospital of Fudan University, Shanghai 200032, China
*Corresponding author)
Abstract:
Objective To explore the effects of delayed umbilical cord clamping (DCC) on early jaundice and intracranial hemorrhage in moderate and late preterm infants. Methods Moderate and late preterm (32-36+6 weeks) infants, who were vaginal delivered from Feb. 1, 2016 to Jan. 31, 2018 in Maternal and Child Health Care Hospital of Shanghai Jiading District, were selected, and were divided into early umbilical cord clamping (ECC) group (who were born during Feb. 1, 2016 to Jan. 31, 2017 with umbilical cord clamping in 15 s after delivery) and DCC group (who were born during Feb. 1, 2017 to Jan. 31, 2018 with umbilical cord clamping after umbilical artery stopped beating). The first day total serum bilirubin level, transcutaneous bilirubin (TcB) level at 1-3 d after birth, the starting time of blue light therapy, the blood routine at 1 d and 7 d after birth and the incidence of intracranial hemorrhage were compared between the two groups. Results A total of 308 preterm infants were included in this study, with 165 cases in the DCC group and 143 cases in the ECC group. There were no significant differences in the basic information of maternal and premature infants, the first day total serum bilirubin level, the starting time of blue light therapy, white blood cell count, platelet count, or the incidence of intracranial hemorrhage between the two groups (all P>0.05). The TcB levels on the 2nd and 3rd d after birth and the hemoglobin levels and hematocrit on the 1st and 7th days after birth in the DCC group were significantly higher than those in the ECC group (all P<0.05). Conclusion DCC can increase hemoglobin level and hematocrit in the early stage of moderate and late preterm infants. It can increase TcB level to a certain extent, but blue light therapy is not necessary for early intervention. DCC does not increase the incidence of intracranial hemorrhage, making it safe and effective for moderate and late preterm infants.
Key words:  delayed umbilical cord clamping  early umbilical cord clamping  premature infant  jaundice  hemoglobin  intracranial hemorrhage