臺灣博碩士論文加值系統

背景：健康足月兒在出生三日後會出現輕微黃疸，隨著天數增加，黃疸也會隨之上升，同時也因生理性脫水而會體重下降，高峰期通常在出院回家後，臨床上發現嬰兒攝取奶量不足是影響體重流失而導致新生兒黃疸再入院的主要原因。
目的：本研究目的為探究新生兒出生三日內體重流失率與出生後72小時高膽紅素血症的相關性，找出不同日體重流失率的理想預測值，預防伴隨可能發生嚴重高膽紅素血症。
研究方法：本研究為回溯性病歷資料分析，蒐集2007年1月至2008年12月期間之新生兒，出生時妊娠週數超過37週且出生體重超過2500公克為研究對象。針對出生後前三日的體重流失率和出生後72小時總血清膽紅素值進行分析，採用Receiver operating characteristic（ROC) 曲線評估不同日體重流失率的理想分界點和預測值，用來預測出生後72小時高膽紅素血症的關係。
研究結果：本研究共篩選出343名新生兒，平均出生體重為3119±352公克，第3天的平均體重流失率為7.07±2.82％。有115人（33.5％）出現顯著高膽紅素血症，出生後72小時平均總血清膽紅素和體重流失率分別為16.8±1.36 mg/dL和8.4± 2.54％（P＜0.05）。出生後前三天體重流失率與72小時高膽紅素血症皆呈現有顯著相關性。依據ROC曲線分析結果，第1天理想體重流失率預測值為3.32％（敏感度68.7％，特異度45.61％）；第2天為7.60％（敏感度46.96％，特異度74.12％）；第3天為8.15％（敏感度57.39％，特異度70.18％），P值皆小於0.05。
結論與建議：本研究結果顯示，出生後前三日體重流失率的理想預測值，可作為臨床上預測出生後72小時續發高膽紅素血症的預測因子，協助臨床照護及時介入補充新生兒奶量之重要依據。

Background: Although most newborns develop some degree of neonatal jaundice and is usually benign. Healthy, full-term infants are expected to lose weight in the first days following birth. Poor caloric intake can cause excessive weight loss in the first days of life and may contribute to the development of hyperbilirubinemia, and associated with the most prevalent diagnosis for readmission.
Objective: To analyze what constitutes normal neonatal weight loss, and when extra supplemental feedings should be considered to prevent significant hyperbilirubinemia.
Methods: We conducted a retrospective chart review from January 2007 to December 2008, healthy, term newborns with a gestational age of more than 37 weeks and a birth body weight above 2500 gm were enrolled. We analyzed the association between body weight loss (BWL) percentage and significant hyperbilirubinemia (total bilirubin more than 15 mg/dL) 72 hours after birth, and receiver operating characteristic (ROC) curves were used to evaluate the appropriate cut-off BWL percentages on the first three days after birth for the prediction of neonatal hyperbilirubinemia 72 hours after birth.
Results: During the study period, 343 neonates were enrolled in our analysis. The mean birth body weight was 3119±352 gm, and the mean BWL percentage on day 3 was 7.07± 2.82%. In addition, 115(33.5%) of the newborns presented with significant hyperbilirubinemia 72 hours after birth. The mean BWL percentage on day 3 was 8.4±2.54%, and the mean total serum bilirubin（TSB）level was 16.8±1.36mg/dl (all p< 0.05) in the significant hyperbilirubinemia group. The BWL percentages within the first 3 days after birth all showed a significant correlation with significant hyperbilirubinemia 72 hours after birth. To predict significant hyperbilirubinemia 72 hours after birth, ROC analysis showed that the optimum cut-off points of BWL percentage were 3.32% on the first day of life (day 1) (sensitivity 68.7%; specificity 45.61%), 7.60% on day 2 (sensitivity 46.96%; specificity 74.12%) and 8.15% on day 3 (sensitivity 57.39%; specificity 70.18%) (all p< 0.05).
Conclusions: BWL percentages on the first three days after birth may serve as a predisposing factor for hyperbilirubinemia, and may also be a useful predicting factor for significant hyperbilirubinemia 72 hours after birth.

中文摘要
英文摘要
目錄i
圖目錄iii
表目錄iv
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的 5
第二章 文獻探討 6
第一節 新生兒黃疸的原因和分類 6
第二節 體重變化和新生兒黃疸的關係 9
第三節 母乳和新生兒黃疸的關係 11
第四節 新生兒黃疸的預防與治療 14
第三章 研究方法 17
第一節 研究設計與資料來源 17
第二節 研究對象 18
第三節 研究測量 19
第四節 統計分析與資料處理 20
第四章 研究結果 21
第一節 研究對象基本資料分析 21
第二節 出生72小時非高膽紅素血症與高膽紅素血症兩組間之差異分析 22
第三節 出生三日內不同體重流失率與72小時總血清膽紅素值之相關性 23
第四節 出生三日內不同體重流失率在72小時高膽紅素血症的預測性 24
第五節 預測出生後72小時高膽紅素血症的前3日理想體重流失率 25
第五章 討論 26
第一節 新生兒出生3日內體重變化與高膽紅素血症之關係 26
第二節 出生3日內不同體重流失率與高膽紅素血症的預測關係 30
第六章 結論與建議 32
第一節 結論 32
第二節 建議 33
第三節 研究限制與未來研究方向 34
參考文獻 35

圖目錄
圖 2-4-1 新生兒高膽紅素血症風險評估圖 44
圖 4-4-1 出生第1 天預測高膽紅素血症之體重流失率的ROC曲線圖 45
圖 4-4-2 出生第2 天預測高膽紅素血症之體重流失率的ROC曲線圖 46
圖 4-4-3 出生第3 天預測高膽紅素血症之體重流失率的ROC曲線圖 47

表目錄
表4-1-1 研究樣本的基本資料 48
表4-2-1 出生72 小時非高膽紅素血症與高膽紅素血症兩組間之差異 49
表4-3-1 不同體重流失率與72 小時總血清膽紅素值之相關性 50
表4-4-1 出生後3 日內不同體重流失率的上下限區間在72 小時高膽紅素血症的預測分析 51
表4-5-1 出生後3 日內不同體重流失率在72 小時高膽紅素血症的理想預測值 52

附錄
附錄一 亞洲大學醫學研究倫理委員會研究計劃審查結果通知書 53

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