| BackgroundNeonatal hyperbilirubinemia means that when bilirubin generation is more than its clearance, total serum bilirubin concentration rises, and clinical manifestation of hyperbilirubinemia appears. It is a common disease with a high incidence Hyperbilirubinemia is divided into unconjugated hyperbilirubinemia and conjugated hyperbilirubinemia. Unconjugated hyperbilirubinemia occurs mostly in neonatal period. The biggest harm of hyperbilirubinemia is that unconjugated bilirubin can traverse the blood-brain barrier, permeate brain cells, and cause bilirubin encephalopathy(kernicterus), which has a high disability rate and mortality rate, poses the huge burden for the family and the society.Phototherapy can make the unconjugated bilirubin decompose and the IxaZ type of bilirubin can be transformed into water-soluble photoisomerization IxaE of bilirubin and lumirubin,which are excreted in the forms of urine and bile, and this can reduce bilirubin. Phototherapy is an effective and convenient method for neonatal hyperbilirubinemia, and has been widely used in clinical setting.Touching, a health care technology, is beneficial to the newborn health. It can bring the benign stimulation for the nervous system and digestive system,make the gastrointestinal peristalsis faster, increase milk intake, and make meconiu discharge as soon as possible to reduce the reabsorption of bilirubin, thereby decreasing the bilirubin levels. In recent years the technology has been used in clinic and gain a good effect.We don't know the effect of combination of touching and phototherapy in newborn with different levels of hyperbilirubinemia.Therefore, randomized control trial was applied in the present research to observe the effect of combination of touching and phototherapy in newborn with different levels of hyperbilirubinemia.Objective:To evaluate the effect of touching in infants with different degrees of hyperbilirubinemia, who are undergoing phototherapy, and to seek for the effective nursing measures to improve the outcome of newborns with hyperbilirubinemia.Subjects and methods:180 full-term infants admitted to Binzhou people's hospital from August 2008 to August 2010 were enrolled. According to total serum bilirubin (TSB) level, infants were divided into three groups, mild(group A,TSB:205.2～265.5umol/L), moderate(group B, TSB:265.6～323.0umol/L), and severe(group C, TSB≥323.0umol/L). Group A was randomly divided into group Al (n=30,experimental group) and group A2 (n=30,control group). Group B was randomly divided into group B1 (n=30, experimental group) and group B2 (n=30,control group), and Group C was also randomly divided into group C1 (n=30, experimental group) and group C2 (n=30, control group). There were not statistically different (P> 0.05) between groups in the sex, age, birth weight, height, Apgar score, and the medical treatments..Infants of experimental groups were given phototherapy, routine care and touching. Touching was given to infants 1 hours after their feeding with their waking status. We used whole body massage twice a day(15 minutes every time). The level of bilirubin was measured and recorded within 6 day. Infants of control groups were only given phototherapy and routine care, without touching. The clinical date such as TSB, milk intake, stool frequency, weight, time of crying and sleep duration were also recorded everyday.Results1. Comparison of the TSB In the mild group (group A), TSB of group Al was significantly lower than that of group A2 in the 1st,2nd and 3rd day(p<0.05). TSB of group A1 was lower than that of group A2 in the 4th,5th and 6th day(p<0.01).In the moderate group (group B), TSB of group B1 was significantly lower than that of group B2 in the 6th day(p<0.01). TSB of group B1 was lower than that of group A2 in the Previous 5 days(p<0.05).In the severe group (group C), TSB of group C1 was significantly lower than that of group C2 in the 3rd,4th and 5th day(p<0.01). TSB of group C1was lower than that of group C2 in the 1st,2nd and 6th day(p<0.05).2. Comparison of daily weightThe experimental groups daily gained more weight than the control groups for the three groups (p<0.01)3. Comparison of daily intake of milkIn three groups, the experimental groups daily got more milk intake significantly than the control groups (p<0.01)4. Comparison of daily stool frequencyIn three groups, the experimental groups daily defecated more frequently than the control groups (p<0.01)5. Comparison of daily crying timeGroup A1 was significantly shorter than group A2 in the 1st,3rd,4th,5th and 6th day(p <0.05). group A1 was significantly shorter than group A2 in the 2nd day(p<0.01). Group B1 was significantly shorter than group B2 in the 1st,2nd and 5th day(p<0.01). group B1 was shorter than group A2 in the 3rd,4th and 6th day(p<0.05). Group C1 was shorter than group C2 in the 1st,2nd,3rd,5th and 6th day(p<0.05). group C1 was significantly shorter than group C2 in the 4th day(p<0.01).6. Comparison of daily sleep durationIn three groups, the experimental groups daily slept more longer than the control groups (p<0.01) 7. Comparison of the hospitalization timeIn three groups, touching together with phototherapy can significantly shortern the length of hospital stay in experimental groups (p<0.05)Conclusions1. Infants with different degrees of hyperbilirubinemia were given combination of phototherapy and touching, blood total serum bilirubin(TSB) can be reduced significantly.2. Infants given touching can get more milk intake, gain more weight and defecate more frequently.3.Touching can improve treatment compliance and promote the development of the nervous system when they are undergoing phototherapy. |
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