Kaplan M, Kaplan E, Hammerman C, Algur N, Bromiker R, Schimmel M S, Eidelman A I
Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel.
Arch Dis Child. 2006 Jan;91(1):31-4. doi: 10.1136/adc.2005.081224. Epub 2005 Oct 13.
To determine the incidence of post-phototherapy neonatal plasma total bilirubin (PTB) rebound.
A prospective clinical survey was performed on 226 term and near-term neonates treated with phototherapy in the well baby nursery of the Shaare Zedek Medical Center from January 2001 to September 2002. Neonates were tested for PTB 24 hours (between 12 and 36 hours) after discontinuation of phototherapy, with additional testing as clinically indicated. The main outcome measure, significant bilirubin rebound, was defined as a post-phototherapy PTB > or =256 micromol/l. Phototherapy was not reinstituted in all cases of rebound, but rather according to clinical indications.
A total of 30 (13.3%) neonates developed significant rebound (mean (SD) PTB 287 (27) micromol/l, upper range 351 micromol/l). Twenty two of these (73%) were retreated with phototherapy at mean PTB 296 (29) micromol/l. Multiple logistic regression analysis showed significant risk for aetiological risk factors including positive direct Coombs test (odds ratio 2.44, 95% CI 1.25 to 4.74) and gestational age <37 weeks (odds ratio 3.21, 95% CI 1.29 to 7.96). A greater number of neonates rebounded among those in whom phototherapy was commenced < or =72 hours (26/152, 17%) compared with >72 hours (4/74, 5.4%) (odds ratio 3.61, 95% CI 1.21 to 10.77).
Post-phototherapy neonatal bilirubin rebound to clinically significant levels may occur, especially in cases of prematurity, direct Coombs test positivity, and those treated < or =72 hours. These risk factors should be taken into account when planning post-phototherapy follow up.
确定光疗后新生儿血浆总胆红素（PTB）反弹的发生率。
对2001年1月至2002年9月在沙雷泽德克医疗中心健康婴儿保育室接受光疗的226例足月儿和近足月儿进行前瞻性临床调查。光疗停止后24小时（12至36小时之间）对新生儿进行PTB检测，并根据临床指征进行额外检测。主要观察指标，即显著胆红素反弹，定义为光疗后PTB≥256微摩尔/升。并非所有反弹病例均重新进行光疗，而是根据临床指征决定。
共有30例（13.3%）新生儿出现显著反弹（平均（标准差）PTB为287（27）微摩尔/升，上限为351微摩尔/升）。其中22例（73%）在平均PTB为296（29）微摩尔/升时重新接受光疗。多因素logistic回归分析显示，病因风险因素包括直接抗人球蛋白试验阳性（比值比2.44，95%可信区间1.25至4.74）和胎龄<37周（比值比3.21，95%可信区间1.29至7.96）存在显著风险。光疗开始时间≤72小时的新生儿中反弹的人数更多（26/152，17%），而光疗开始时间>72小时的新生儿中反弹人数为4/74（5.4%）（比值比3.61，95%可信区间1.21至10.77）。
光疗后新生儿胆红素可能反弹至临床显著水平，尤其是在早产、直接抗人球蛋白试验阳性以及光疗开始时间≤72小时的病例中。在计划光疗后随访时应考虑这些风险因素。
