预约演示

更新于：2025-05-07

Jaundice, Neonatal

新生儿黄疸

更新于：2025-05-07

基本信息

别名

ICTERUS NEONATORUM、Icterus Gravis Neonatorum、Icterus gravis neonatorum

+ [53]

简介

Yellow discoloration of the SKIN; MUCOUS MEMBRANE; and SCLERA in the NEWBORN. It is a sign of NEONATAL HYPERBILIRUBINEMIA. Most cases are transient self-limiting (PHYSIOLOGICAL NEONATAL JAUNDICE) occurring in the first week of life, but some can be a sign of pathological disorders, particularly LIVER DISEASES.

关联

项与新生儿黄疸相关的药物

Stannsoporfin

靶点

HMOX1 x HMOX2

作用机制

HMOX1抑制剂 [+1]

在研机构-

原研机构

Shire Development LLC

在研适应症-

非在研适应症

高胆红素血症 [+4]

最高研发阶段终止

首次获批国家/地区-

首次获批日期1800-01-20

295

项与新生儿黄疸相关的临床试验

NCT06837935

/ Not yet recruitingN/AIIT

Effect of Aluminum Foil Reflector on Phototherapy for Newborn Infants with Unconjugated Hyperbilirubinemia: a Randomized Controlled Trial

Hyperbilirubinemia is defined as the presence of bilirubin in the serum of newborns at levels exceeding the normal range. It is the most common problem among healthy newborns, with an incidence of approximately 40% to 60% in full-term infants. The primary cause is the immature bilirubin metabolism in newborns, leading to the accumulation of excess bilirubin in the blood, which in turn results in a temporary yellowing of the skin and sclera, known as jaundice. Physiological jaundice in full-term newborns typically appears 24 to 72 hours after birth, peaking on days 4 to 5. Studies have shown that neonatal jaundice is a leading cause of readmission after discharge.
Phototherapy is the most effective and safest treatment for neonatal hyperbilirubinemia. It takes advantage of bilirubin's sensitivity to light, converting bilirubin into water-soluble conjugated bilirubin, which is then excreted through bile and urine, thereby reducing total bilirubin levels. The most effective light during phototherapy has a wavelength of 400 nm to 520 nm and an intensity of at least 30 microW/cm²/nm, with at least 80% of the infant's body surface area exposed.
This study aims to investigate whether using aluminum foil reflective covering around the phototherapy incubator can enhance the effectiveness of light treatment for jaundice in infants, thus potentially reducing the duration of phototherapy required.

开始日期2025-05-01

申办/合作机构

台北医学大学

NCT06921330

/ Not yet recruitingN/AIIT

The Effect of White Cover and Massage Application on Bilirubin Levels and Duration of Phototherapy in Newborns With ABO Incompatibility Receiving Phototherapy

This study aims to examine the effect of white cover and massage application on bilirubin levels and phototherapy duration in newborns with ABO incompatibility receiving phototherapy.

开始日期2025-04-15

申办/合作机构

Karabuk University

NCT06702241

/ Not yet recruiting临床2/3期IIT

Neonatal Hyperbilirubinemia - Phototherapeutic Treatment Strategies

Background Neonatal jaundice affects about 60% of full-term newborns in their first week. If untreated, it can lead to permanent brain damage. In Denmark, 2-5% of newborns require phototherapy, the standard treatment. The maximum beneficial irradiance limit for phototherapy remains unclear. Furthermore, studies suggest that cycled phototherapy is as effective as continuous treatment.
This study aims to investigate the efficacy of elevating the irradiance of intensive phototherapy treatment regimens. This is to evaluate the dose-response relationship. Furthermore, the study aims to compare intermittent phototherapy to continuous phototherapy.
Methods:
In a clinical randomized multicenter trial 116 newborns with non-hemolytic hyperbilirubinemia, gestational age >33+0, weight >1800g and no other significant neonatal diagnose will be randomized. All infants will receive 12 hours double therapy with a biliblanket and overhead light providing an intensity of either 40-, 55- or 70 µW/cm2/nm. Three groups will be treated with continuous phototherapy while a fourth group will receive intermittent phototherapy of 1,5 hours cycled intervals with an intensity of 70 µW/cm2/nm.
Parental experiences during treatment will be examined through a survey post treatment.
The study has been approved by the Regional Research Ethics Committee.
Perspectives:
Understanding the dose-response relationship of phototherapy will give an insight in the most effective way of treating neonatal jaundice. Intermittent therapy, if proven non-inferior, could facilitate more intimacy in the parent-infant relationship as well as benefits in initiating breastfeeding

开始日期2025-01-02

申办/合作机构

Aalborg University Hospital

100 项与新生儿黄疸相关的临床结果

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100 项与新生儿黄疸相关的转化医学

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0 项与新生儿黄疸相关的专利（医药）

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3,914

项与新生儿黄疸相关的文献（医药）

2025-12-31·The Journal of Maternal-Fetal & Neonatal Medicine

Meta-analysis of the efficacy of different blue light therapy methods for neonatal jaundice

Article

作者: Wu, Ruoya ; Wen, Lingling

OBJECTIVETo analyze and evaluate the efficacy of different blue light therapy methods and provide evidence-based recommendations for their selection in clinical practice.METHODSClinical randomized controlled trials (RCTs) evaluating the efficacy of various blue light therapy methods for neonatal jaundice were retrieved from both domestic and international databases. The search period covered the inception of each database until November 2023. After screening, the quality of the included studies was assessed using the Cochrane Risk of Bias tool. Literature management was conducted with NoteExpress 3.2, while data collection and extraction were performed using Excel 2003. Statistical analysis was carried out using RevMan 5.4.1. Heterogeneity was assessed using the Q test (p value), and the OR value of the combined effect was calculated using either a fixed-effects or random effects model, depending on the presence of heterogeneity. A forest plot was generated to visualize the results. Sensitivity analysis was performed by excluding the largest-weighted study, and the potential for bias in outcome indicators was assessed using a funnel plot.RESULTSA total of 652 articles were retrieved, with 16 clinical RCTs meeting the inclusion criteria. The meta-analysis results indicated that, compared to continuous blue light therapy in the control group, intermittent blue light therapy achieved a higher total effective rate (OR = 1.82, 95%CI (1.25-2.64), p = .002), significantly lower serum bilirubin levels post-treatment (OR = -14.59, 95%CI (-26.11 to -3.08), p = .01), and a shorter time to jaundice resolution (OR = -2.35, 95%CI (-3.83 to -0.87), p = .002). Additionally, the incidence of adverse reactions was lower in the intermittent therapy group compared to the control group (OR = 0.27, 95%CI (0.19-0.36), p < .00001). Sensitivity analysis confirmed that the combined effect size was stable and reliable (OR (95%CI) = -16.23 (-28.67 to -3.79), p = .01). The funnel plot suggested potential publication bias.CONCLUSIONSIntermittent blue light therapy is effective and demonstrates significant clinical benefits, making it a valuable treatment option for neonatal jaundice in clinical practice.

2025-06-01·Molecular Genetics and Metabolism Reports

A novel SLC44A gene variant in a patient with neonatal cholestasis and liver failure

Article

作者: Karakoyun, Miray ; Canda, Ebru ; Aydogdu, Sema ; Onay, Huseyin ; Dörtkardeşler, Emine Burçe ; Barut, Dogan

SLC44A1 gene variants (MIM # 618868) are associated with a choline transporter deficiency with a rare autosomal recessive genetic disorder characterized by neurodegeneration, childhood-onset with ataxia, tremor, optic atrophy, and cognitive decline. Variants in the SLC44A1 gene are considered to be responsible for the syndrome. We reported a four-month-old baby with neonatal cholestasis and liver failure, but neurological development and examination were normal. During the patient's initial physical examination, height, weight, and head circumference were < -2 SDS. He was alert, with eye tracking and a smile present, appeared icteric, and exhibited hepatosplenomegaly, with a history of second-degree consanguinity between his parents. The patient showed signs of neonatal jaundice, elevated transaminases, and episodes of hypoglycemia. After excluding biliary atresia, tyrosinemia, and other metabolic diseases, mitochondrial hepatopathy, vascular pathologies, and congenital infectious diseases through all standard examinations for neonatal cholestasis, a genetic analysis test and whole exome analysis were conducted. Molecular analysis of the whole exome revealed a novel inherited mutation, one inherited from each parent. This novel variant in the SLC44A1 gene is c.1632 + 1G > A. A thorough physical examination and laboratory tests should be conducted for patients presenting with neonatal cholestasis. Subsequently, whole exome analysis from the parents identified the same mutation as heterozygous c.1632 + 1G > A in the SLC44A1 gene. Genetic examinations should be considered in patients whose cause remains undetermined, particularly when there is a family history.ConclusionWe describe a novel childhood-onset liver failure and metabolic disease caused by choline transporter deficiency with autosomal recessive inheritance.

2025-06-01·Journal of Diabetes and its Complications

A retrospective study to investigate the risk factors for gestational diabetes mellitus and its impact on maternal and neonatal outcomes

Article

作者: Wang, Yonghui ; Zhang, Xiujuan ; Gao, Xia ; Chen, Shenglin ; Zhao, Huirong

BACKGROUNDCurrently, risk factors for gestational diabetes mellitus (GDM) and its impact on maternal and neonatal outcomes have not been fully elucidated. Therefore, we performed a retrospective epidemiologic study to explore the above research objectives.METHODSWe collected extensive clinical data from January 2020 to June 2023 for 855 maternity cases at the Department of Obstetrics and Gynecology, Chaoyang Hospital, Capital Medical University. Vitamin D deficiency, undergoing assisted reproductive techniques, advanced maternal age (≥35), multiparas, abortion history, pre-pregnancy body mass index (≥25.0), twin pregnancy, polycystic ovary syndrome (PCOS), family history of diabetes, history of delivering a low-birth-weight infant, and weight gain during gestation of >2 kg per month (mean) as variables that may affect GDM to investigate the risk factors for GDM. In addition, a total of 15 adverse postpartum outcomes (including maternal complications and neonatal complications) were used to explore the adverse effects of maternal comorbidity with GDM. Variables that were significant in the univariate logistic regression model were included in the multivariate logistic regression model. Receiver operating characteristic (ROC) curves were conducted for the ability to predict the risk of the GDM and its impact on maternal and neonatal outcomes, using variables derived from the multivariate logistic regression models.RESULTSThe results of multivariate logistic regression analyses shown that only multipara was not a risk factor for the development of GDM. Postpartum hemorrhage (blood loss ≥500 ml) and the neonatal Apgar score (≤9) (all P > 0.05) was excluded in the multivariate logistic regression model. According to the results of multivariate logistic regression analyses, the incidence of hypothyroid complications, hyperlipidemic complications, postpartum anemia, gestational hypertension, racket placenta, premature rupture of membranes, fetal malposition, macrosomia (≥4000 g), low-birth-weight infants (<2500 g), prematurity, neonatal infections, neonatal jaundice, and fetal distress was higher in pregnancies with combined GDM (all P < 0.05). The model demonstrated excellent diagnostic performance, with an area under the ROC curve of 0.91, indicating its efficacy in predicting adverse prognostic outcomes associated with maternal GDM.CONCLUSIONSIt is essential for women of childbearing age to correct vitamin D deficiency as well as to maintain their body mass index within the normal range before preparing for pregnancy. Maternal weight gain needs to be managed appropriately throughout pregnancy, which may reduce the risk of GDM to some extent. Therefore, our results suggest that effective measures to reduce the risk of GDM are essential for both the mother and the newborn.

项与新生儿黄疸相关的新闻（医药）

2025-03-29

·梅斯医学

新生儿宝宝变成“小黄人”，大便白如陶土！出生40天紧急手术，竟因胆道被锁死！

3岁的女孩小鹏，从出生开始就与常人不同。他的皮肤黄染，黄疸并未得到缓解，家人初时以为是新生儿黄疸，过几天就能好转。然而，随着时间推移，小鹏的黄疸并未退去，体重增长缓慢，胃口差，哭闹不断。最令人担忧的是，他的腹部膨胀越来越明显，肝脏肿大，皮肤上渐现小血点。家人带他去医院检查，首先排除了感染等常见疾病。接下来，经过B超检查，医生发现小鹏的肝脏和脾脏肿大，胆囊也表现出异常情况。进一步的影像学检查和肝功能检测确认了先天性胆道闭锁（BA）。新生儿疾病先天性胆道闭锁(BA)是一种罕见的新生儿疾病。患儿出生后不久就会表现出阻塞性黄疽的症状。病变一般最初发生在肝外胆道,如未经及时治疗可迅速向肝内胆道发展,引引起严重的胆汁淤积和迅速发展的肝硬化。患儿随即出现肝脾肿大,腹水,静脉曲张,凝血功能减退等肝功能失代偿和门脉高压征象,严重者可致死亡。分型胆道闭锁（BA）按病因学和发病特点分为四型：第I型为Alagille综合症（胆道闭锁脾脏畸形综合症），患者常有脾脏畸形、内脏转位、肝后下腔静脉缺如、心脏畸形等，女性多发，且在东亚及有色人种中较为常见。该型病理表现为肝外胆道萎缩，预后较差，手术难度较大。第II型为猫眼综合症，表现为神经系统、眼耳部畸形，约31%的患者伴有胆道闭锁，还可能有直肠-肛门闭锁和心脏畸形，占BA的10%左右，I型较为常见。第III型为囊肿型BA，占BA的10%。尽管该型曾认为病变较小，预后较好，但近年来研究发现其肝内外胆道有明显炎性浸润，预后较差，且需要肝移植的比例与其他类型相当。第IV型是最常见的单发型BA，约占80%以上，发病率存在地域差异，如在欧洲为1/15000-1/19000，在中国台湾为1/5400-1/5800，患者无明显性别和季节差异，预后相对较好。诊断胆道闭锁（BA）的早期诊断至关重要，尤其是90天以内进行Kasai手术能显著提高预后。研究显示，70天以内手术预后无明显差异，但超过90天，肝移植间隔时间缩短，手术成功率降低，因此早发现、早治疗非常关键。目前，没有单一的确诊检查，诊断需通过多步骤鉴别。常用筛查方法包括血清直接胆红素水平、粪便比色卡和B超检查，但这些方法的敏感度和特异度有限。肝脏活检和HBS SPECT诊断准确率较高，MRCP和B超的表现较差。研究还显示，苯巴比妥的使用可以提高HBS的诊断准确性。此外，血清学小分子如ICAM-1和miR-200b/429也有潜力作为BA的诊断标志物，提供了新的诊断思路。治疗肝移植是治愈胆道闭锁（BA）的唯一手段，但研究表明，肝移植越晚进行，患者的并发症发生率和死亡率越低。因此，对于肝功能迅速恶化或未能及时进行Kasai手术的患儿，肝移植成为一线治疗。Wang等人的研究表明，与Kasai手术相比，肝移植作为一线治疗的术后一月生存率相近，但术后一年生存率显著更高（84%比61%）。然而，供肝稀缺、术后需长期免疫抑制以及高昂的费用仍是肝移植的短板。确定哪些患儿在Kasai手术后最终需要肝移植是当前研究的重点。研究发现，PELD评分>15分或手术时大于60天的患儿发生肝功能衰竭的风险显著增加。Kawahara等人的研究则表明，术后3个月内，直接胆红素（DB）>0.7mg/dl或谷草转氨酶（AST）>94IU/L是预后不良的提示因素。参考文献：[1]单禹华,龙喜带,夏强.先天性胆道闭锁最新研究进展[J].肝胆外科杂志,2014,22(02):154-157.[2]郭振亚,张若岩,柳明江,等.先天性胆道闭锁的病因研究进展[J].临床肝胆病杂志,2015,31(08):1343-1346.[3]李鑫,潘娟.小婴儿胆道闭锁的手术配合[J].当代护士(中旬刊),2016,(12):79-81.来源 | 梅斯医学编辑 | wanny神经系统罕见病交流群↓点击下方“阅读原文”，下载梅斯医学APP吧！

2025-03-02

·药事纵横

FDA批准CtexliTM（chenodiol）用于治疗罕见病脑腱黄瘤病

2025年2月21日，FDA批准了CtexliTM（chenodiol）用于治疗成人脑腱黄瘤病（Cerebrotendinous Xanthomatosis，CTX）。在此之前FDA同时授予其优先审评、快速通道和孤儿药资格认定。CtexliTM是全球首个获得FDA批准用于治疗CTX的药物。 1、CTX发病机理脑腱黄瘤病是一种罕见的遗传性胆汁酸合成障碍疾病，由CYP27A1基因突变引起，导致一种参与人体胆固醇转化为胆去氧胆酸的线粒体酶（甾醇27-羟化酶）缺乏，为常染色体阴性遗传性代谢疾病。由于肝脏胆汁酸生成减少，CTX患者无法正常分解胆固醇，导致异常的代谢产物，如胆固醇和胆烷醇在神经细胞和细胞膜中沉积，累及大脑、肝脏、皮肤、肌腱、脊髓、晶状体等。 CTX的病理生理学示意图[1] 2、流行病学发病率和患病率全球范围内CTX的发病率估计在1/36042到1/468624之间；在美国，CTX的患病率估计为每10万人中3到5例。目前已报告的全球病例数约仅为425例，而实际患病人数可能远高于此，CTX的临床表现多样且复杂，包括慢性腹泻、白内障、腱黄色瘤、神经功能障碍等，症状的起始和严重程度差异较大，导致该病常被误诊或漏诊，提示该病可能被严重低估。临床表现 CTX的症状通常从儿童期开始展现，如慢性腹泻、新生儿黄疸等，随后可能出现白内障（青少年期）、腱黄色瘤（青年期）和神经功能障碍（成年期）。由于症状多样且缺乏特异性，CTX的平均确诊年龄为35.5岁，导致许多患者在疾病晚期才被诊断，错过了预防不可逆神经损伤的时机。 3、CtexliTM（chenodiol）基本信息Chenodiol主要成分为胆去氧胆酸（chenodeoxycholic acid，CDCA），是一种内源性初级胆汁酸。CtexliTM通过补充体内缺乏的胆去氧胆酸，恢复胆汁酸的正常代谢，减少异常代谢产物的积累。同时，补充的胆去氧胆酸水平的增加可以激活法尼酯X受体（FXR），进而下调胆固醇7α-羟化酶（CYP7A1）的表达。CtexliTM针对脑腱黄瘤病曾在2017年04月10日获得EMA批准，商品名是Chenodeoxycholic acid leadiant （previously chenodeoxycholic acid sigma-tau）®，为规格是250 mg的硬胶囊剂型。本次获批剂型为250mg的口服片剂。 3α,7α-二羟基-5-β-胆烷-24-酸，分子式为C₂₄H₄₀O₄，分子量为392.58 g/mol 临床结果CtexliTM本次获批基于一项随机、双盲、安慰剂对照、2周期、2治疗交叉试验（NCT04270682）的临床试验数据。共纳入14名患者，其中13名患者被随机分配并按照交叉撤药设计接受250 mg或安慰剂，持续4周，共两个双盲治疗期。研究还包括在2个双盲撤药期之间进行的8周导入期和8周开放标签期。在13名随机分配的患者中，62%为男性，39%为女性。基线中位年龄为42岁（16-55岁），中位确诊年龄为35岁（15-55岁）。长达24周的试验表明，与安慰剂组相比，CtexliTM（250 mg×3/day）治疗可显著降低CTX患者血浆胆烷醇和尿液23S-戊醇水平。随机分配的患者按治疗顺序观察到的血浆胆固醇醇的平均值血浆胆固醇醇和尿液23S-戊醇的总结结果安全性 NCT04270682试验评估产品的不良反应发生率。其中发生率≥14%的最常见不良反应为腹泻（36%）、头痛（21%）和腹痛（14%）、便秘（14%）、高血压（14%）、肌无力（14%）和上呼吸道感染（14%）。1例接受CTEXLITM治疗的患者（7%）出现ALT水平升高超过正常上限3倍，导致治疗中断。 4、竞品格局目前全球针对CTX适应症的上市产品仅CtexliTM一款。此外，由Vivet Therapeutics研发的一种腺相关病毒载体基因疗法VTX-806，VTX-806通过AAV载体将功能性CYP27A1基因递送至肝脏，恢复正常的胆汁酸合成。目前正在临床前研究阶段，接受AAV8-EAAT-CYP27A1基因疗法的CTX小鼠，其肝脏重量相对于体重的比例显著下降，接近野生型小鼠的水平，体现出剂量依赖的肝肿大逆转能力[5]。该疗法已于2024年9月获得EMA授予的孤儿药资格。 VTX-806基因疗法逆转CTX小鼠的肝肿大[5] 总结：孤儿药研发在政策支持、技术创新和市场需求的推动下，正迎来快速发展。未来，精准医疗和基因疗法的进步将进一步提高孤儿药的研发效率。然而，如何平衡经济激励与患者可及性，确保孤儿药的可持续发展，仍是行业面临的重要挑战。CTX作为一种进展性多系统疾病，对患者影响显著，此前一直缺乏获批的治疗方法。今天CtexliTM批准为CTX患者提供了一种安全且有效的治疗选择。资料引自： 1、Nobrega PR, Bernardes AM, Ribeiro RM, et al. Cerebrotendinous xanthomatosis: a practice review of pathophysiology, diagnosis, and treatment. Front Neurol. (2022) 13:1049850. doi: 10.3389/fneur.2022.1049850. 2、LING C X, GAO S Z, LI R D, et al. Cerebrotendinous xanthomatosis presenting with schizophrenia-like disorder: A case report[J]. World J Psychiatry, 2023, 13(11): 967-972. DOI: 10.5498/wjp.v13.i11.967. 3、Chenodiol药物说明书 4、Clinical trials.com 5、Lumbreras, S., Ricobaraza, et al. . Gene supplementation of CYP27A1 in the liver restores bile acid metabolism in a mouse model of cerebrotendinous xanthomatosis. Molecular Therapy: Methods & Clinical Development (2021), 22, 210-221. 药事纵横投稿须知：稿费已上调，欢迎投稿

优先审批孤儿药快速通道

2024-10-15

·梅斯医学

出生仅4天，新生儿医院照蓝光期间死亡！家属称：孩子趴了一个半小时，前面40分钟还在动，后面就没动静了，等医生发现就直接开始抢救了

【#当地回应新生儿医院照蓝光期间死亡#：已成立专班调查死因】#4天大新生儿医院照蓝光期间死亡# 近日，湖北宜昌一位网友在社交媒体发布视频称，其刚出生几天的侄子在宜昌市夷陵区妇幼保健院照蓝光治疗期间离世。视频发布者称，孩子父母备孕8年，在10月4日生下一名男婴。10月8日，产妇出院，婴儿因为黄疸值高被留在医院照蓝光治疗。当日下午2时和6时，婴儿爸爸两次去医院送奶水，当时婴儿状态正常。当晚11时，家属突然接到医院通知，称孩子已经离世。视频显示：“看了监控视频，孩子趴了一个半小时，前面40分钟还在动，后面就没动静了，等医生发现就直接开始抢救了。医院依然没有给出合理解释。”10月8日11时42分，夷陵区一新生儿因“新生儿重度高胆红素血症”入住区妇幼保健院新生儿科治疗，10月9日2时26分经抢救无效不幸死亡，引发家属质疑。卫健局高度重视，第一时间成立工作专班开展调查，将根据调查情况依法依规严肃处理。 11日下午，红星新闻联系夷陵区妇幼保健院核实相关情况，工作人员表示，该院正在调查处理此事，之后将会对外通报具体情况。同日，夷陵区卫生健康局工作人员对红星新闻表示，当地已就此事成立工作专班，正在对孩子的死因进行调查。该事件暂时还未定性为医疗事故，具体情况正在调查中。看完此消息，引起了广泛关注，评论区有网友称——新生儿黄疸不需要干预。医院为了挣钱，把黄疸当成很大的事去治疗。然而，评估新生儿的黄疸水平是非常重要。如果达到了干预水平，那么需要蓝光治疗，甚至要考虑换血疗法。因为胆红素水平极高的情况下，如果不经治疗，可导致新生儿脑损伤。 2022年9月，美国儿科学会（AAP）发布了更新版的《胎龄35周及以上新生儿高胆红素血症管理指南》。该指南提供了最新的光疗和换血标准，旨在降低胆红素脑病的风险，并减少不必要的干预。以下是基于2022版AAP指南的主要光疗和换血标准：光疗标准 1. 光疗阈值：对于足月或接近足月（≥35周胎龄）的新生儿，当总血清胆红素（TSB）水平达到特定阈值时，应开始光疗。这些阈值根据新生儿的日龄和是否存在高危因素来确定。通常情况下，如果TSB超过小时胆红素列线图的第95百分位数，建议进行光疗。 2. 高危因素下的调整：如果存在高胆红素血症神经毒性的高危因素，如胎龄<38周、白蛋白<3.0 g/dL、溶血性疾病、败血症等，光疗的阈值应该下调20。新生儿在出生后24小时内出现黄疸或其他临床状况不稳定的情况，也应考虑提前或更积极地进行光疗。 3. 监测与评估：在光疗期间，应定期监测TSB水平，以确保其下降到安全范围内。使用经皮胆红素测量（TcB）作为筛查工具，但当TcB接近光疗阈值或TSB > 15 mg/dL时，需要进一步测定TSB。换血标准 1. 换血阈值：当TSB水平达到非常高的水平，超过了光疗的最大效果范围，或者存在急性胆红素脑病的迹象时，可能需要进行换血治疗。对于足月或接近足月的新生儿，换血的标准通常是TSB > 427 μmol/L (约25 mg/dL) 或者在光疗无效的情况下。对于早产儿或存在高危因素的新生儿，换血的阈值更低，可能在TSB > 342 μmol/L (约20 mg/dL) 时就需要考虑换血。 2. 紧急情况：如果新生儿出现任何急性胆红素脑病的症状，如肌张力低下、嗜睡、吸吮无力、尖叫、发热等，即使TSB未达到常规换血阈值，也可能需要立即进行换血。在某些特殊情况下，如严重的同族免疫性溶血病（例如Rh血型不合），换血可能是首选治疗方法。实践建议个体化处理：每个新生儿的情况都是独特的，因此治疗决策应该基于全面的临床评估，包括胆红素水平、日龄、出生体重和其他相关健康状况。密切监测：无论是光疗还是换血治疗，都需要密切监测新生儿的生命体征和胆红素水平变化。持续教育和支持：家长和护理人员应该了解黄疸的原因、治疗方法及其重要性，并参与到治疗过程中来，以便更好地支持新生儿的健康。家庭参与家庭陪伴：鼓励父母在孩子接受蓝光治疗时留在病房内陪伴，这不仅有助于增进亲子关系，还能让家长更早地察觉到孩子的任何变化，并及时通知医护人员。母乳喂养：继续支持母乳喂养，除非有医学指征需要中断。对于母乳性黄疸，只要婴儿精神状态良好且体重增长正常，一般不需要中断母乳喂养。除了要关注蓝光治疗的医学指征外，趴睡可能增加婴儿猝死综合症（SIDS）发病风险。SIDS指引起婴幼儿突然死亡的症候群，本病根据患儿健康状态及既往病史完全不能预知，且常规病理解剖也不能发现明显的致死原因。从1994年美国儿科学会、美国婴儿猝死综合征联合会等共同发起“仰卧睡觉”运动以来，婴儿猝死综合征的发生率已经下降了40%。在进行蓝光治疗时，也不需要改变睡姿。如果确实需要采取俯卧位来促进治疗效果或其它医疗目的，必须有医护人员持续监测婴儿的心率、呼吸频率以及氧饱和度等关键生命体征。此悲剧提醒我们，在处理新生儿黄疸等常见问题时需格外谨慎。医疗机构应当加强对患者安全的关注，同时加强与家庭成员之间的沟通合作，共同为新生儿创造最适宜的成长环境。希望相关部门能够尽快查明真相，给公众一个满意的答复，并从中吸取教训，完善相关流程和规范，防止类似事件再次发生。来源 | 梅斯医学综合整理编辑 | rayms 授权转载及爆料请联络梅斯医学管理员点击下方“阅读原文” 下载梅斯医学APP吧！