产科出院后因严重高胆红素血症住院新生儿入院前随访情况及随访依从性影响因素的多中心调查

Preadmission follow-up condition of neonates hospitalized due to severe hyperbilirubinemia after discharge from the department of obstetrics and influencing factors for follow-up compliance: a multicenter investigation

摘要:

目的 调查产科出院后因严重高胆红素血症住院新生儿入院前的随访情况及随访依从性的影响因素。 方法 该研究是一个多中心回顾性病例对照研究。病例来源于2019年1月至2021年4月江苏省新生儿严重高胆红素血症质量改进临床研究协作组12家单位的多中心临床数据库。根据自产科出院后是否按时进行新生儿黄疸随访，分为随访依从性好和依从性差两组。采用多因素logistic回归模型分析患儿入院前随访依从性的影响因素。 结果 共纳入严重高胆红素血症新生儿545例，其中随访依从性好组156例（28.6%），依从性差组389例（71.4%）。多因素logistic回归分析显示：低出生胎龄、入院体重较出生体重下降比例≥10%、既往子女光疗、既往子女换血、母亲Rh（-）血型、母亲文化水平高、产科出院前医护人员采用微信公众号的方式提醒随访、出院后采用电话告知方式提醒随访均与随访依从性增加有关（P<0.05）。 结论 严重高胆红素血症新生儿产科出院后随访依从性较差，提示需要进一步加强出院前对家长进行黄疸知识宣教，提高黄疸随访意识；建议通过电话或微信公众号等方式督促提醒家长按时随访。 引

Abstract:

Objective To investigate the preadmission follow-up condition of neonates hospitalized due to severe hyperbilirubinemia after discharge from the department of obstetrics and the influencing factors for follow-up compliance. Methods A multicenter retrospective case-control study was performed for the cases from the multicenter clinical database of 12 units in the Quality Improvement Clinical Research Cooperative Group of Neonatal Severe Hyperbilirubinemia in Jiangsu Province of China from January 2019 to April 2021. According to whether the follow-up of neonatal jaundice was conducted on time after discharge from the department of obstetrics, the neonates were divided into two groups: good follow-up compliance and poor follow-up compliance. The multivariate logistic regression model was used to identify the influencing factors for follow-up compliance of the neonates before admission. Results A total of 545 neonates with severe hyperbilirubinemia were included in the study, with 156 neonates (28.6%) in the good follow-up compliance group and 389 (71.4%) in the poor follow-up compliance group. The multivariate logistic regression analysis showed that low gestational age at birth, ≥10% reduction in body weight on admission compared with birth weight, history of phototherapy of siblings, history of exchange transfusion of siblings, Rh(-) blood type of the mother, a higher educational level of the mother, the use of WeChat official account by medical staff to remind of follow-up before discharge from the department of obstetrics, and the method of telephone notification to remind of follow-up after discharge were associated with the increase in follow-up compliance (P<0.05). Conclusions Poor follow-up compliance is observed for the neonates with severe hyperbilirubinemia after discharge from the department of obstetrics, which suggests that it is necessary to further strengthen the education of jaundice to parents before discharge and improve the awareness of jaundice follow-up. It is recommended to remind parents to follow up on time by phone or WeChat official account.