目的 研究新生儿高胆红素血症对3月龄婴儿神经行为发育的影响,为临床治疗和早期评估预后提供依据。方法 选取2014年8月-2016年4月桂林医学院附属医院住院的114例高胆红素血症患儿作为研究对象,依据血清胆红素水平(Sb)分为3组:低水平组(46例,Sb＜257 μmol/L)、中水平组(31例,Sb 257～342 μmol/L)和高水平组(37例,Sb＞342 μmol/L)。入院时进行脑干听觉诱发电位(BAEP)检查,异常者月龄满3月时复查。月龄满3月时对所有患儿进行智能测试。结果 低、中、高胆红素水平组入院时第1次BAEP检查异常率分别为34.8%(16/46)、51.6%(16/31)和64.9%(24/37),差异有统计学意义(P＜0.05)。智力发展指数(MDI)、精神运动发展指数(PDI)评分随胆红素值的升高而降低,与胆红素值呈显著负相关(r＝-0.583,-0.574,P＜0.001)。初筛BAEP异常的患儿智能发育明显落后于初筛BAEP正常的患儿(P＜0.05)。但3月龄时复查BAEP仅3例异常。结论 BAEP是病理性黄疸脑损伤的敏感指标,但 BAEP不能单独作为病理性黄疸患儿神经系统是否恢复正常的指标,应配合定期的神经行为检查,以便于早期发现神经系统异常,早期干预,减少后遗症发生。

Objective To investigate the influence of neonatal pathological jaundice on the neurobehavioral development of 3-month-old infants,in order to provide evidence for early clinical treatment and early evaluation of prognosis. Methods Totally 114 neonates with pathological jaundice treated in the Affiliated Hospital of Guilin Medical College from August 2014 to April 2016 were enrolled in this study, and were divided into three groups according to different levels of serum bilirubin concentration, including low level group(46 case, Sb<257 μmol/L),moderate level group(31 cases, Sb 257-342 μmol/L)and high level group(37 cases, Sb> 342 μmol/L).Infants received brainstem auditory evoked potentials (BAEP) test on admission and the abnormal cases would be retested BAEP at the age of 3 months old. Intelligent tests were conducted in all infants at their age of 3 months old. Results The abnormality rates of first BAEP test at admission in low level group, moderate level group and high level group were 34.8%(16/46), 51.6%(16/31) and 64.9%(24/37),respectively. And the difference was significant among three groups(P＜0.05).The scores of (mental development index,MDI) and (psychomotor development mdex,PDI) increased with the decrease of Sb level, and were negatively correlated with Sb level(r＝-0.583,-0.574,P＜0.001). And there was significant delay in the cases with abnormal BAEP results for the primary screening compared with normal ones. However, only three cases were abnormal in BAEP test at the age of 3 months old. Conclusions BAEP is a sensitive index of cerebral injury in children with neonatal pathological jaundice, but not an indicator for the recovery of patients′ nervous system independently. So it is suggested that together with regular neurobehavioral development test, BAEP warrants timely abnormal condition of nervous system for pediatricians in order to give early intervention and improve the prognosis.