新生儿高胆红素血症的临床评估与出院后管理策略研究进展
Research Progress on Clinical Assessment and Post-Discharge Management Strategies for Neonatal Hyperbilirubinemia
摘要: 新生儿高胆红素血症是新生儿期最常见的临床问题之一,严重者可导致急性胆红素脑病及核黄疸,造成不可逆的神经系统后遗症,其临床评估与出院后管理至关重要。本文旨在系统综述该领域的临床评估与出院后管理策略的最新进展。首先概述了新生儿高胆红素血症的流行病学特征、风险评估工具及治疗策略。在此基础上,重点探讨了出院后随访管理的现状与面临的挑战,包括再入院的风险因素。同时,本文分析了家庭监测与远程医疗等新兴技术在优化出院后管理中的应用潜力。通过整合最新临床研究证据,本综述旨在为临床制定科学、有效且安全的出院后管理计划提供循证依据,以期降低严重并发症发生率和再入院率。
Abstract: Neonatal hyperbilirubinemia is one of the most common clinical problems in the neonatal period. Severe cases can lead to acute bilirubin encephalopathy and kernicterus, resulting in irreversible neurological sequelae, making its clinical assessment and post-discharge management crucial. This article aims to systematically review the latest advances in clinical assessment and post-discharge management strategies for this condition. It first outlines the epidemiological characteristics, risk assessment tools, and treatment strategies for neonatal hyperbilirubinemia. Building on this foundation, the paper focuses on the current status and challenges of post-discharge follow-up management, including risk factors for hospital readmission. Furthermore, it analyzes the potential application of emerging technologies, such as home monitoring and telemedicine, in optimizing post-discharge care. By integrating the latest clinical research evidence, this review aims to provide an evidence-based rationale for clinicians to develop scientific, effective, and safe post-discharge management plans, with the goal of reducing the incidence of severe complications and hospital readmissions.
文章引用:马笑笑, 郝莉霞. 新生儿高胆红素血症的临床评估与出院后管理策略研究进展[J]. 临床医学进展, 2026, 16(5): 2494-2504. https://doi.org/10.12677/acm.2026.1652059

参考文献

[1] Chen, K. and Yuan, T. (2020) The Role of Microbiota in Neonatal Hyperbilirubinemia. American Journal of Translational Research, 12, 7459-7474.
[2] Qian, S., Kumar, P. and Testai, F.D. (2022) Bilirubin Encephalopathy. Current Neurology and Neuroscience Reports, 22, 343-353. [Google Scholar] [CrossRef] [PubMed]
[3] Pillai, A., Pandita, A., Osiovich, H. and Manhas, D. (2020) Pathogenesis and Management of Indirect Hyperbilirubinemia in Preterm Neonates Less than 35 Weeks: Moving toward a Standardized Approach. NeoReviews, 21, e298-e307. [Google Scholar] [CrossRef] [PubMed]
[4] Qattea, I., Farghaly, M.A.A., Elgendy, M., Mohamed, M.A. and Aly, H. (2022) Neonatal Hyperbilirubinemia and Bilirubin Neurotoxicity in Hospitalized Neonates: Analysis of the US Database. Pediatric Research, 91, 1662-1668. [Google Scholar] [CrossRef] [PubMed]
[5] van der Geest, B.A.M., de Mol, M.J.S., Barendse, I.S.A., de Graaf, J.P., Bertens, L.C.M., Poley, M.J., et al. (2022) Assessment, Management, and Incidence of Neonatal Jaundice in Healthy Neonates Cared for in Primary Care: A Prospective Cohort Study. Scientific Reports, 12, Article No. 14385. [Google Scholar] [CrossRef] [PubMed]
[6] Bergmann, Á.U. and Þórkelsson, Þ. (2020) Alvarleg gula hjá nýburum—Nýgengi og áhættuþættir. Læknablaðið, 2020, 139-143. [Google Scholar] [CrossRef] [PubMed]
[7] Blumovich, A., Mangel, L., Yochpaz, S., Mandel, D. and Marom, R. (2020) Risk Factors for Readmission for Phototherapy Due to Jaundice in Healthy Newborns: A Retrospective, Observational Study. BMC Pediatrics, 20, Article No. 248. [Google Scholar] [CrossRef] [PubMed]
[8] Okwundu, C., Bhutani, V.K., Smith, J., Esterhuizen, T.M. and Wiysonge, C. (2020) Predischarge Transcutaneous Bilirubin Screening Reduces Readmission Rate for Hyperbilirubinaemia in Diverse South African Newborns: A Randomised Controlled Trial. South African Medical Journal, 110, 249-254. [Google Scholar] [CrossRef] [PubMed]
[9] Khurshid, F., Rao, S.P., Sauve, C. and Gupta, S. (2022) Universal Screening for Hyperbilirubinemia in Term Healthy Newborns at Discharge: A Systematic Review and Meta-Analysis. Journal of Global Health, 12, Article No. 12007. [Google Scholar] [CrossRef] [PubMed]
[10] Sampurna, M.T.A., Ratnasari, K.A., Irawan, Z.S., Etika, R., Utomo, M.T., Corebima, B.I.R.V., et al. (2022) Evaluation of a Mobile Application Tool (Bilinorm) to Improve Care for Newborns with Hyperbilirubinemia in Indonesia. PLOS ONE, 17, e0269286. [Google Scholar] [CrossRef] [PubMed]
[11] Yan, Q., Gong, Y., Luo, Q., Yin, X., Yang, L., Wang, H., et al. (2022) Effects of a Smartphone-Based Out-of-Hospital Screening App for Neonatal Hyperbilirubinemia on Neonatal Readmission Rates and Maternal Anxiety: Randomized Controlled Trial. Journal of Medical Internet Research, 24, e37843. [Google Scholar] [CrossRef] [PubMed]
[12] Li, Q.Q., Dong, X.Y., Qiao, Y., et al. (2020) [An Investigation of Severe Neonatal Hyperbilirubinemia in 13 Hospitals of Jiangsu Province, China]. Chinese Journal of Contemporary Pediatrics, 22, 690-695.
[13] Donneborg, M.L., Hansen, B.M., Vandborg, P.K., Rodrigo-Domingo, M. and Ebbesen, F. (2020) Extreme Neonatal Hyperbilirubinemia and Kernicterus Spectrum Disorder in Denmark during the Years 2000-2015. Journal of Perinatology, 40, 194-202. [Google Scholar] [CrossRef] [PubMed]
[14] Ahmad, M., Rehman, A., Adnan, M. and Surani, M.K. (2020) Acute Bilirubin Encephalopathy and Its Associated Risk Factors in a Tertiary Care Hospital, Pakistan. Pakistan Journal of Medical Sciences, 36, 1189-1192. [Google Scholar] [CrossRef] [PubMed]
[15] Aynalem, S., Abayneh, M., Metaferia, G., Demissie, A.G., Gidi, N.W., Demtse, A.G., et al. (2020) Hyperbilirubinemia in Preterm Infants Admitted to Neonatal Intensive Care Units in Ethiopia. Global Pediatric Health, 7. [Google Scholar] [CrossRef] [PubMed]
[16] Almohammadi, H., Nasef, N., Al-Harbi, A., Saidy, K. and Nour, I. (2022) Risk Factors and Predictors of Rebound Hyperbilirubinemia in a Term and Late-Preterm Infant with Hemolysis. American Journal of Perinatology, 39, 836-843. [Google Scholar] [CrossRef] [PubMed]
[17] Yue, P.X., Cao, H.L. and Li, R. (2025) [Risk Factors and Construction of a Risk Prediction Model for Readmission Due to Hyperbilirubinemia in Neonates with ABO Hemolytic Disease of the Newborn]. Chinese Journal of Contemporary Pediatrics, 27, 834-841.
[18] Xu, C., Bao, Y., He, Y., Wu, M. and Zhu, J. (2023) Risk Factors for Readmission for Hyperbilirubinemia in Neonates with ABO Hemolytic Disease: A Single-Center Retrospective Cohort Study. The Journal of Maternal-Fetal & Neonatal Medicine, 36, Article ID: 2238106. [Google Scholar] [CrossRef] [PubMed]
[19] Ercin, S., Coskun, Y., Kayas, K., Kavas, N. and Gursoy, T. (2021) Positive Direct Antiglobulin Test: Is It a Risk Factor for Significant Hyperbilirubinemia in Neonates with ABO Incompatibility? American Journal of Perinatology, 41, 505-510. [Google Scholar] [CrossRef] [PubMed]
[20] Routray, S.S., Behera, R., Mallick, B., Acharya, D., Sahoo, J.P., Kanungo, G.N., et al. (2021) The Spectrum of Hemolytic Disease of the Newborn: Evaluating the Etiology of Unconjugated Hyperbilirubinemia among Neonates Pertinent to Immunohematological Workup. Cureus, 13, e16940. [Google Scholar] [CrossRef] [PubMed]
[21] Achenjang, N., Jadczak, E., Ryan, R.M. and Nock, M.L. (2025) Hereditary Spherocytosis: Review of Presentation at Birth. Children, 12, Article 1207. [Google Scholar] [CrossRef
[22] Mei, H., Dong, X., Wu, B., Wang, H., Lu, Y., Hu, L., et al. (2022) Clinical and Genetic Etiologies of Neonatal Unconjugated Hyperbilirubinemia in the China Neonatal Genomes Project. The Journal of Pediatrics, 243, 53-60.e9. [Google Scholar] [CrossRef] [PubMed]
[23] Xu, J., Lin, F., Wu, Y., Chen, Z., Ma, Y. and Yang, L. (2023) Etiology Analysis for Term Newborns with Severe Hyperbilirubinemia in Eastern Guangdong of China. World Journal of Clinical Cases, 11, 2443-2451. [Google Scholar] [CrossRef] [PubMed]
[24] Baz, A.M.K., El-Agamy, O.A.E. and Ibrahim, A.M. (2024) Incidence of Urinary Tract Infection in Neonates with Significant Indirect Hyperbilirubinemia of Unknown Etiology: Case-Control Study. Italian Journal of Pediatrics, 47, Article No. 35. [Google Scholar] [CrossRef] [PubMed]
[25] Jensen, D., Drazick, A., Boote, R. and Lim, P.P. (2024) Raoultella Planticola Urinary Tract Infection Presenting as Hyperbilirubinemia in a 3-Day-Old Infant. South Dakota Medicine, 77, 274-279.
[26] Huang, T. and Duan, M. (2024) G6PD Gene Detection in Neonatal Hyperbilirubinemia and Analysis of Related Risk Factors. Technology and Health Care, 32, 565-572. [Google Scholar] [CrossRef] [PubMed]
[27] Edwards, M., Falzone, N. and Harrington, J. (2021) Conjugated Hyperbilirubinemia among Infants with Hyperinsulinemic Hypoglycemia. European Journal of Pediatrics, 180, 1653-1657. [Google Scholar] [CrossRef] [PubMed]
[28] Cui, Z., Shen, W., Sun, X., Li, Y., Liu, Y. and Sun, Z. (2024) Developing and Evaluating a Predictive Model for Neonatal Hyperbilirubinemia Based on UGT1A1 Gene Polymorphism and Clinical Risk Factors. Frontiers in Pediatrics, 12, Article 1345602. [Google Scholar] [CrossRef] [PubMed]
[29] Wang, X., Xiao, T., Wang, J., Wu, B., Wang, H., Lu, Y., et al. (2024) Clinical and Genetic Risk Factors Associated with Neonatal Severe Hyperbilirubinemia: A Case-Control Study Based on the China Neonatal Genomes Project. Frontiers in Genetics, 14, Article 1292921. [Google Scholar] [CrossRef] [PubMed]
[30] Wang, J., Guo, G., Li, A., Cai, W. and Wang, X. (2021) Challenges of Phototherapy for Neonatal Hyperbilirubinemia (Review). Experimental and Therapeutic Medicine, 21, Article No. 231. [Google Scholar] [CrossRef] [PubMed]
[31] Zhan, Y., Peng, H., Jin, Z., Su, J., Tan, X., Zhao, L., et al. (2023) Higher ETCOc Predicts Longer Phototherapy Treatment in Neonatal Hyperbilirubinemia. Frontiers in Pediatrics, 11, Article 1154350. [Google Scholar] [CrossRef] [PubMed]
[32] Sampurna, M.T.A., Etika, R., Utomo, M.T., Rani, S.A.D., Irzaldy, A., Irawan, Z.S., et al. (2020) An Evaluation of Phototherapy Device Performance in a Tertiary Health Facility. Heliyon, 6, e04950. [Google Scholar] [CrossRef] [PubMed]
[33] Guan, X., Guo, J., Xiao, D. and Wu, Z. (2024) The Effect of Different Dose of Heparin Using in Peripheral Arteriovenous Synchronous Blood Exchange Transfusion for Neonatal Hyperbilirubinemia. Journal of Medical Biochemistry, 43, 126-132. [Google Scholar] [CrossRef] [PubMed]
[34] Williams, C., Tack, V., Basu, S. and Rosenstein, E. (2025) Exchange Transfusion via Peripheral Access for Neonate with Hyperbilirubinemia and Hereditary Spherocytosis in the Nicu. Advances in Neonatal Care, 25, 549-554. [Google Scholar] [CrossRef
[35] Zhu, S., Zhou, L., Feng, Y., Zhu, J., Shu, Q. and Li, H. (2022) Understanding the Risk Factors for Adverse Events during Exchange Transfusion in Neonatal Hyperbilirubinemia Using Explainable Artificial Intelligence. BMC Pediatrics, 22, Article No. 567. [Google Scholar] [CrossRef] [PubMed]
[36] Zhang, M., He, Y., Tang, J., Dong, W., Zhang, Y., Zhang, B., et al. (2022) Intensive Phototherapy vs. Exchange Transfusion for the Treatment of Neonatal Hyperbilirubinemia: A Multicenter Retrospective Cohort Study. Chinese Medical Journal, 135, 598-605. [Google Scholar] [CrossRef] [PubMed]
[37] Belide, S., Uddin, M.W., Kumar, S., Sethi, R.K., Diwakar, K. and Jhajra, S. (2023) Clinical Study to Determine the Predictability of Significant Rebound Hyperbilirubinemia in Neonates after Phototherapy and Conditions Likely to Be Associated with It: Prospective Observational Study in a Teaching Hospital in Eastern India. Journal of Family Medicine and Primary Care, 12, 3362-3367. [Google Scholar] [CrossRef] [PubMed]
[38] Li, R., Li, T., Yan, X., Feng, J., Yu, Z. and Chen, C. (2024) Efficacy of Home Phototherapy versus Inpatient Phototherapy for Neonatal Hyperbilirubinemia: A Systematic Review and Meta-Analysis. Italian Journal of Pediatrics, 50, Article No. 37. [Google Scholar] [CrossRef] [PubMed]
[39] Wu, R., Jiang, Y., Yan, J., Shen, N., Liu, S., Yin, H., et al. (2024) Beneficial Changes in Gut Microbiota after Phototherapy for Neonatal Hyperbilirubinemia. Biomedical Reports, 20, Article No. 101. [Google Scholar] [CrossRef] [PubMed]
[40] Zheng, Y., Almeyda-Alejo, Y., Tumin, D., Redpath, N.S.J. and Guillen-Hernandez, J. (2024) Three or Four Doses of Intravenous Immunoglobulin G Treatment for Isoimmune Hemolytic Disease: A Case Series and Literature Review. Journal of Neonatal-Perinatal Medicine, 17, 153-158. [Google Scholar] [CrossRef] [PubMed]
[41] Daunov, M., Schlosser, A., Malay, S., Adams, J., Clark, R., Ferrerosa, L., et al. (2024) A Description of IVIG Use in Term Neonates with ABO Incompatibility. American Journal of Perinatology, 41, 1761-1766. [Google Scholar] [CrossRef] [PubMed]
[42] Yang, F., Liu, Y., Zheng, F., Yao, Q. and Mo, W. (2022) Efficacy of Circumferential Intensive Phototherapy in Treating Neonatal Hyperbilirubinemia: A Pilot Study. American Journal of Perinatology, 39, 425-428. [Google Scholar] [CrossRef] [PubMed]
[43] Olusanya, B.O., Omololu, O.M., Osamebor, F.B., Olufosoye, A., Alo, T., Olaifa, S.M., et al. (2026) Filtered-Sunlight Phototherapy for Newborns with Moderate-To-Severe Hyperbilirubinemia: A Randomized Trial. Pediatric Research, 99, 174-182. [Google Scholar] [CrossRef] [PubMed]
[44] Ronca, K., Vazquez, L., Bathory, E. and Nafday, S. (2024) Rehospitalization Following Discharge from Newborn Nursery during Severe Acute Respiratory Syndrome Coronavirus 2 Pandemic. American Journal of Perinatology, 41, 1828-1835. [Google Scholar] [CrossRef] [PubMed]
[45] Cai, Y., Li, X., Wang, P. and Song, Y. (2025) Predictive Factors for Readmission Due to Neonatal Hyperbilirubinemia: A Retrospective Case-Control Study. PLOS ONE, 20, e0320767. [Google Scholar] [CrossRef] [PubMed]
[46] Okwundu, C.I., Bhutani, V.K., Uthman, O.A., Smith, J., Olowoyeye, A., Fiander, M., et al. (2024) Transcutaneous Bilirubinometry for Detecting Jaundice in Term or Late Preterm Neonates. Cochrane Database of Systematic Reviews, No. 5, CD011060. [Google Scholar] [CrossRef] [PubMed]
[47] Steffens, B., Koch, G., Engel, C., Franz, A.R., Pfister, M. and Wellmann, S. (2025) Assessing Accuracy of Bilipredics Algorithm in Predicting Individual Bilirubin Progression in Neonates—Results from a Prospective Multi-Center Study. Frontiers in Digital Health, 7, Article 1497165. [Google Scholar] [CrossRef] [PubMed]
[48] Hameed, N.N., Yousif, H.N. and Fawzi, H.A. (2020) Assessment of Adherence Level for Neonatal Hyperbilirubinemia Management by Various Physicians in Iraq: A Multi-Clinic Study. F1000Research, 9, Article 504. [Google Scholar] [CrossRef] [PubMed]
[49] Wang, Z.Q., Gao, Y., Dong, X.Y., et al. (2022) [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]. Chinese Journal of Contemporary Pediatrics, 24, 669-674.
[50] So, V. and Khurshid, F. (2022) Treatment Practices and Implementation of Guidelines for Hyperbilirubinemia and Rebound Hyperbilirubinemia. Journal of Neonatal-Perinatal Medicine, 15, 335-343. [Google Scholar] [CrossRef] [PubMed]
[51] Xu, C., Bao, Y., Zhu, J., et al. (2020) [Remote Monitoring of Neonatal Jaundice in Newborns with ABO Hemolytic Disease]. Journal of Zhejiang University Medical Sciences, 49, 651-655.
[52] Kang, M. (2025) Clinical Superiority of Artificial Intelligence-Enabled Jaundice Monitoring Follow-Up Combined with End-Tidal Carbon Monoxide Measurement in Neonatal Jaundice Management. American Journal of Translational Research, 17, 8601-8611. [Google Scholar] [CrossRef
[53] Du, Q., Wu, X., Wang, J., Ma, Y., Ma, H. and Jia, R. (2025) Analysis of Obstetric Nursing Interventions for Home Monitoring of Neonatal Jaundice. Journal of Multidisciplinary Healthcare, 18, 6901-6909. [Google Scholar] [CrossRef