关键词: 胆汁淤积,新生儿,早产儿

Abstract: Objective To analyze the clinical data of neonatal cholestasis and analyze its difference between different onset time.Methods A total of 46 cases of neonatal cholestasis were retrospectively analyzed from January 2016 to December 2020 at the Department of Neonatology of Hunan Children’s Hospital. According to the onset time of cholestasis, all children were divided into early onset group (onset within 2 weeks after birth) and late onset group (onset after 2 weeks after birth). The general clinical data, biochemical indexes and prognosis of the two groups were observed. The age of onset, gestational age, birth weight, months of recovery, total bilirubin, conjugated bilirubin, total bile acid, alanine aminotransferase (ALT), γ-glutamyl transpeptidase (GGT) and alkaline phosphatase (AKP) were statistically compared between the two groups by independent sample t-test. Chi-square test was used to statistically compare the sex composition ratio, the proportion of full-term infants, the cure rate, the composition ratio of different etiologies, the incidence of clay colored stool and the proportion of hepatomegaly between the two groups.Results 1. There were no significant differences in sex composition, cure time, proportion of infectious cholestasis, total bilirubin, direct bilirubin, total bile acid, GGT and AKP between two groups (P>0.05). The average disease onset age of early onset group was (5.91±4.61) d and that of late onset group was (36.8±14.1d). The average gestational age of early onset group was higher than that of late onset group [(35.4±2.8) w vs (31.6±2.5) w] . The average birth weight of early onset group was (2001.8±522.2) g, higher than that of late onset group [(1477.3±356.4) g], the difference was statistically significant (t=11.21, 4.325, 3.111, P<0.05). Full term infants accounted for 36.4% in early onset group, and there were all premature infants in late onset group. The cure rate of early onset group (72.3%) was lower than that of late onset group (100%).There were 0 case of venous nutrition-related cholestasis in early onset group, which was significantly lower than that in late onset group (48.6%). The proportion of cholestasis with unknown cause in early onset group (63.4%) was higher than that in late onset group (28.6%). The proportion of clay colored stool in early onset group (36.4%) was higher than that in late onset group (8.6%), and the difference was statistically significant (χ²=13.939, 10.21, 8.475, 4.417, 5.011, P<0.05). The ALT level in the early onset group was (142.3±122.8) IU/L, which was significantly higher than that in the late onset group (77.5±46.4) IU/L, the difference was statistically significant (t=2.625, P=0.012). The mean cure age of all cured children was 3.4 months.Conclusion There are differences in clinical characteristics of cholestasis between the early onset group and the late onset group. The gestational age, birth weight and ALT level of the early onset group are higher than those of the late onset group, and the proportions of unexplained cholestasis, clay colored stool and full term infants are higher, and the prognosis is worse. The late onset group has a higher proportion of venous nutrition-related cholestasis and a better prognosis.

Key words: Neonatal, Cholestasis, Premature