Alpay F, Sarici S U, Tosuncuk H D, Serdar M A, Inanç N, Gökçay E
Department of Pediatrics, Gülhane Military Medical Academy, Ankara, Turkey.
Pediatrics. 2000 Aug;106(2):E16. doi: 10.1542/peds.106.2.e16.
The recognition, follow-up, and early treatment of neonatal jaundice has become more difficult, since the earlier discharge of newborns from hospitals has become common practice. This prospective study was undertaken to identify the newborns at risk for developing significant hyperbilirubinemia later during the first days of life by measuring the serum bilirubin levels of the first 5 days of life to determine the critical predictive serum bilirubin value on the first day of life.
A total of 498 healthy term newborns were followed with daily serum total bilirubin measurements for the first 5 days of life, and cases with serum bilirubin levels of >/=17 mg/dL after 24 hours of life were defined to have significant hyperbilirubinemia.
No newborns had a serum total bilirubin level of >/=17 mg/dL in the first 72 hours of life. Sixty of 498 cases (12.05%) had significant hyperbilirubinemia after 72 hours of life, and these cases had significantly higher bilirubin levels than those who did not develop significant hyperbilirubinemia on each of the first 5 days' measurements. Of the 206 newborns who had a serum bilirubin level of >/=6 mg/dL in the first 24 hours, 54 (26.21%) developed significant hyperbilirubinemia, whereas only 6 of the 292 newborns (2.05%) who had a serum bilirubin level of <6 mg/dL on the first day developed significant hyperbilirubinemia. A mean serum bilirubin level of >/=6 mg/dL on the first day had the highest sensitivity (90%). At this critical serum bilirubin value, the negative predictive value was very high (97.9%) and the positive predictive value was fairly low (26.2%). Furthermore, because no cases with a serum bilirubin level of <6 mg/dL in the first 24 hours of life required a subsequent phototherapy treatment and because all of those infants requiring a phototherapy treatment with serum bilirubin levels of >/=20 mg/dL were just among the cases whose first-day bilirubin levels were >/=6 mg/dL, the critical bilirubin level of 6 mg/dL on the first day made it possible, with the highest (100%) sensitivity and negative predictive value, to definitely predict all of the infants who would have a bilirubin level of >20 mg/dL, requiring a phototherapy treatment later during the first days of life.
A serum bilirubin measurement and the use of the critical bilirubin level of 6 mg/dL in the first 24 hours of life will predict nearly all of the term newborns who will have significant hyperbilirubinemia and will determine all those who will require a phototherapy treatment later during the first days of life.
由于新生儿更早出院已成为普遍做法，新生儿黄疸的识别、随访及早期治疗变得更加困难。本前瞻性研究旨在通过测量出生后前5天的血清胆红素水平，确定出生第一天的关键预测血清胆红素值，以识别出生后最初几天有发生显著高胆红素血症风险的新生儿。
共对498名健康足月儿在出生后前5天每天进行血清总胆红素测量，并将出生24小时后血清胆红素水平≥17mg/dL的病例定义为有显著高胆红素血症。
在出生后的前72小时内，没有新生儿的血清总胆红素水平≥17mg/dL。498例中有60例（12.05%）在出生72小时后发生显著高胆红素血症，这些病例在出生后前5天每次测量时的胆红素水平均显著高于未发生显著高胆红素血症的病例。在出生后24小时内血清胆红素水平≥6mg/dL的206名新生儿中，54例（26.21%）发生显著高胆红素血症，而出生第一天血清胆红素水平<6mg/dL的292名新生儿中只有6例（2.05%）发生显著高胆红素血症。出生第一天平均血清胆红素水平≥6mg/dL时敏感性最高（90%）。在此关键血清胆红素值时，阴性预测值非常高（97.9%），阳性预测值相当低（26.2%）。此外，由于出生后24小时内血清胆红素水平<6mg/dL的病例均无需后续光疗，且所有血清胆红素水平≥20mg/dL需要光疗的婴儿都在出生第一天胆红素水平≥6mg/dL的病例中，出生第一天6mg/dL的关键胆红素水平能够以最高（100%）的敏感性和阴性预测值明确预测所有出生后最初几天内胆红素水平>20mg/dL需要光疗的婴儿。
出生后24小时内进行血清胆红素测量并使用6mg/dL的关键胆红素水平，几乎可以预测所有将发生显著高胆红素血症的足月儿，并能确定所有出生后最初几天内需要光疗的婴儿。
