探討運用黃疸辨識卡對於提升主要照顧者新生兒黃疸膚色辨識之成效

Use of a Skin Color Chart by Primary Caregivers to Recognize Neonatal Jaundice

10.6142/VGHN.201912_36(4).0006

羅佩佳(Pei-Jia Luo)；黃照伶(Chao-Ling Huang)；周惠婷(Hui-Ting Chou)；彭雪芳(Hsueh-Fang Peng)；沈青青(Ching-Ching Sheng)

新生兒黃疸 ； 高膽紅素血症 ； 黃疸辨識卡 ； neonatal jaundice ； hyperbilirubinemia ； skin color chart

榮總護理

36卷4期（2019 / 12 / 01）

376 - 385

繁體中文

本研究旨在探討運用黃疸辨識卡能否提升主要照顧者辨識新生兒黃疸膚色的成效。本研究採兩階段評價設計，第一階段查閱2012－2015年新生兒中重度病房病歷，比較2014年1月全面推動黃疸辨識卡前後兩組新生兒高膽紅素血症（TcB值 ＞ 18mg/dl）之發生率；第二階段採類實驗研究設計，於2016年1月1日至12月31日以黃疸辨識卡為護理介入措施，探討北部某醫學中心嬰兒室新生兒主要照顧者辨識新生兒黃疸膚色的正確率。研究結果顯示，病歷查閱發現黃疸辨識卡介入前後，由嬰兒室出院之新生兒因黃疸再入院的高膽紅素血症發生率由26.32%降為9.14%，達統計上顯著差異（p ＜. 001）。第二階段共收案200位新生兒主要照顧者，結果發現主要照顧者使用黃疸辨識卡辨識出生後2－4天新生兒膚色之正確率達88.8%。顯示黃疸辨識卡可有效幫助照顧者對新生兒黃疸膚色辨識進而降低新生兒進展成高膽紅素血症發生率，把握及時就診時機，避免核黃疸造成永久性傷害及帶給家庭與社會沉重的負擔。

This study evaluated the use of a skin color chart by primary caregivers to recognize neonatal jaundice. A two-wave study design was employed to evaluate the effectiveness of this chart. A medical review was applied in the first period, and the incidence of hyperbilirubinemia (TcB ＞ 18 mg/dl) between the two groups before and after the comprehensive promotion of the color chart in January 2014 were compared. During the second wave, a quasi-experimental study was conducted from January 1 to December 31, 2016, with the newborns in the baby room of a northern Taiwan medical center. The skin color chart is a nursing intervention that was introduced by nurses to the primary caregivers of the newborns. In total, 200 newborns and their primary caregivers participated in this study. The results demonstrated that the readmission rate due to hyperbilirubinemia decreased from 26.31% in 2012 to 9.14% in 2015 (p ＜ .001; i.e., after the review of NBR medical records and popularization of the skin color chart in the hospital). Furthermore, the correct recognition rate of newborn skin color 2-4 days after birth in primary caregivers was 88.8% after conducting the skin color chart intervention with the caregivers. In summary, the skin color chart is an effective intervention to help caregivers identify newborn jaundice and reduce the incidence of neonatal progression to hyperbilirubinemia. Early detection of hyperbilirubinemia may help prevent permanent damage caused by nuclear jaundice and the consequent heavy burden on families and society.

1. American Academy of Pediatrics.(2004).Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation.Pediatrics,114(1),297-316.
2. Dantas, A. V. V. C.,Farias, L. J. R.,de Paula, S. J.,Moreira, R. P.,da Silva, V. M.,de Oliveira Lopes, M. V.,Guedes, N. G.(2018).Nursing diagnosis of neonatal jaundice: Study of clinical indicators.Journal of Pediatric Nursing,39,e6-e10.
3. Edgar, D.(1969).Audiovisual methods in teaching.Germany:The Dryden Press.
4. Gosset, I. H.(1960).A Perspex icterometer for neonates.The Lancet,275(7115),87-88.
5. Johnson, L.,Bhutani, V. K.(2011).The clinical syndrome of bilirubin-induced neurologic dysfunction.Seminars in Perinatology,35(3),101-113.
6. MacDonald, M. G.(Ed.)(2016).Neonatology.New York:Wolters Kluwer.
7. Madlon-Kay, D. J.(2002).Maternal assessment of neonatal jaundice after hospital discharge.Journal of Family Practice,51(5),445-448.
8. Marcdante, K.,Kliegman, R.,Behrman, R.,Jenson, H.(2010).Nelson Essentials of Pediatrics.Elsevier Health Sciences.
9. Mukhopadhyay, K.,Chowdhary, G.,Singh, P.,Kumar, P.,Narang, A.(2010).Neurodevelopmental outcome of acute bilirubin encephalopathy.Journal of Tropical Pediatrics,56(5),333-336.
10. Pichon, J. B. L.,Riordan, S. M.,Watchko, J.,Shapiro, S. M.(2017).The neurological sequelae of neonatal hyperbilirubinemia: Definitions, diagnosis and treatment of the kernicterus spectrum disorders (KSDs).Current Pediatric Reviews,13(3),199-209.
11. Sanders, D. A.,Sanders, J. A.(1984).Teaching creativity through metaphor: An integrated brain approach.Longman Publishing Group.
12. Stevenson, D.,Maisels, M. J.,Watchko, J.(2012).Care of the Jaundiced Neonate.McGraw Hill Professional.
13. Volpe, J. J.(2008).Bilirubin and brain injury, Neurology of the Newborn.Philadelphia, PA:WB Saunders.
14. 莊舜雯、羅佩佳、黃照伶、李延慧、彭雪芳、沈青青(2015)。運用黃疸辨識卡提升主要照顧者對新生兒黃疸膚色辨識之知能。榮總護理，32(4)，343-350。
15. 陳月枝校閱(2014)。實用兒科護理。台北:華杏。
16. 黃美智校閱、蔣立琦校閱(2013)。兒科護理學。台北:永大。