2013-01-012024-05-13https://scholars.lib.ntu.edu.tw/handle/123456789/647638摘要：背景：新生兒黃疸是相當常見的問題，由於近年來衛生署積極推動母乳哺育政策，我國嬰兒母乳哺育率明顯提升。因此新生兒延長性黃疸超過出生後兩週甚至四週者相當常見。肝外膽汁滯留症之中以膽道閉鎖為兒童肝病常見之致死原因，及換肝的主因。雖有部份嬰兒延遲性黃疸是因為嚴重的膽汁滯留所引起，卻常被誤以為是母乳哺育所造成黃疸，以致延誤早期診治時機，而失去生命，或需要換肝。我們於2009將兒童健康手冊中大便卡不正常顏色由三色增為六色，大便卡提昇為九色大便卡及建立新直接/總膽紅素微量檢測法，期望減少誤認大便顏色的情形及提升早期精確診斷及檢驗的便利性，降低對嬰兒的侵略性；此外目前一般醫師通常以腳根微量採血，但只檢測總膽紅素取代之，而多數仍然以抽取嬰兒靜脈血，這是家長較難接受的，因此我們希望改變抽血方式同時減少嬰兒抽血量，以增加家長對於嬰兒抽血的意願。大多數醫護人員對延遲性黃疸嬰兒同時檢驗直接及總膽紅素的觀念仍認知不足，尚待積極推廣。若能使病童在出生後及早發現及診斷，接受葛西氏手術，能顯著地改善這些病童的預後情形。本計畫之目的及方法如下：目的：探討以全國嬰兒大便顏色卡及新直接/總膽紅素微量檢驗法，篩檢嬰兒延遲性黃疸，鑑別母乳哺育黃疸與膽汁滯留黃疸，提升早期診斷膽道閉鎖，減少肝臟功能受損情形，早期施行葛西手術，提昇原肝存活率，及減少換肝的機率。研究方法：1.了解參與嬰兒延遲性黃疸鑑別診斷課程之醫院，其該執行現況或困難之處，協助改善及克服微量檢測困難之情形，及調訪已可施行微量檢測之經驗醫院，訪問內容包括儀器、耗材相關成本及技術、人力設置等分析，提供政策參考及蒐集相關之建議。2.立意取樣調查全台各年度於不同地區各層級醫院的醫師與護理人員，對於九色嬰兒大便卡的執行現況、成效、困難及改進建議。3.在台灣全體小兒腸胃科醫師的協助下，將持續維持台灣膽道閉鎖通報機制，收集全台通報的膽道閉鎖個案資料，長期追蹤病童預後情形，暸解個案黃疸情形、大便顏色是否有變化以及是否接受肝臟移植手術；分析國內嬰兒肝膽疾病之發生率、接受診治之相關統計(如：接受手術天數與比率等)，及追蹤後續存活率、換肝等資訊之相關性，期望提升早期發現大便顏色異常、早期診斷及手術，減少肝臟功能受損情形，及減少換肝的機率，協助家屬術前之心理建設與術後照顧。4. 維持嬰兒大便卡諮詢專線(02-2382-0886)，協助嬰兒照顧者對嬰兒大便顏色及黃疸問題相關的正確認知及異常大便顏色通報功能。5. 持續將新微量檢測法及全國嬰兒大便顏色卡，以101年專家會議中得到共識擬出提升嬰兒延遲性黃疸鑑別診斷之簡報教材，針對不同的重要對象，提供適當的簡報教材，推廣至各醫學會及全國醫療院所，各年度於不同地區，每年至少3場，期望以極少的血量與精確的方法檢測直接/總膽紅素，與透過簡單觀察大便顏色，鑑別母乳哺育黃疸與膽汁滯流黃疸，精確鑑別是否為膽道閉鎖，進而早期發現與治療。6.提升醫療機構以「預防注射網路通報系統」進行嬰兒膽道閉鎖症之篩檢通報率，加強教育與落實嬰兒大便顏色篩檢工作，期望逐年提升參與線上登錄作業系統之篩檢通報率，及時掌握大便顏色異常個案，給予輔導或轉介；鼓勵新生兒父母在嬰兒滿30天大時至健兒門診施打B肝疫苗第二劑時，帶嬰兒大便回到醫療院所，主動給醫護人員檢視，同時教育醫護人員務必詢問嬰兒大便顏色，並將大便顏色篩檢結果上網登錄。<br> Abstract: Backgoround :Neonatal jaundice is a common health problem. In recent years, due to the success of breast feeding promotion policy, the rate of breast feeding jaundice increased remarkably. It is quite common to find prolonged neonatal jaundice at two or even four weeks old. Biliary atresia is an important disease of extra-hepatic cholestasis and is the leading cause of liver death and liver transplantation in children. Part of the neonates with prolonged jaundice are caused by cholestasis, but often mis-considered as breast feeding jaundice, thus delays the opportunity of early diagnosis and timely operation, and lost their life or needs liver transplantation. We have increase the number of abnormal stool color from 3 to 6 in the stool color card of the children’s health booklet in 2009, and established a new direct/total bilirubin micro-detection method, aiming to reduce the misrecognition of the stool color, and to promote accurate diagnosis and the convenience of blood taking procedure, to reduce the invasiveness to the infants and the willingness of the parents to accept the blood test. Most medical personnel still are unfamiliar with the simultaneous detection of direct/total bilirubin for infants with prolonged jaundice, thus requiring further promotion. If infants with biliary atresia can be diagnosed and operated earlier, the prognosis of those infants will be improved. Aims and Methods of This project :Aims :Using stool color cared and new direct/total bilirubin micro-detection method to screen infants with prolonged jaundice, to differentiate breast feeding jaundice, promote early diagnosis of biliary atresia, reduce liver injury, increase native liver survival, and to reduce the chance of liver transplantation. Methods :1.To understand the status and difficulties of the participating hospitals on conducting micro-detection of direct/total bilirubin; to visit the hospitals which already have experience of the micro-detection system to understand their machine, techniques, cost, personnel, etc. for future reference of our policy and to collect their suggestions. 2.Interest sampling the doctors and nurses from different levels of hospitals, to understand the the current status, effect, difficulties and suggestions for improvement of the 9-colored stool color card.3.Under the assistance of pediatric gastroenterologists, we will maintain the bilirary atresia reporting system, to collect cases of biliary atresia in Taiwan, long term follow-up their outcome to understand their status of jaundice, stool color, the annual incidence, diagnosis and treatment status ( e.g. age at and rates of Kasai operation), annual survival rate, and liver transplantation rate.4.Maintain a consultation telephone line (02-23820886) to assist caretakers of the infants with abnormal stool color and jaundice for the correct recognition of infantile jaundice and cholestasis and the reporting system of the infant stool color. 5.Using the conclusions of the 2012 expert concensus meeting, we will provide educational materials and conferences for the members of related medical societies and hospitals in Taiwan, to introduce new micro-detection method of direct/total bilirubin and also the stool color screening system. These activities will be held at least three times per year, aiming to promote the accurate differential diagnosis of cholestasis and breast feeding jaundice, and early therapy.6.Promote the online reporting rate of medical organizations in using the DOH “immunization online reporting system” to screen and report the stool color of infants, hoping to increase the participating rate of the medical organizations year by year. Then, infants with abnormal stool color will be referred timely. Encourage the caretakers of the neonates to bring the stool of their infants when they return hospital/ clinic for the 2nd dose of hepatitis B vaccine at 30 days of age, and to educate the medical personnel to ask the stool color and record it online.新生兒黃疸直接膽紅素嬰兒大便卡膽道閉鎖膽汁滯留症性別分析neonatal jaundicecholestasisbiliary atresiainfant stool color carddirect bilirubin