Moerschel Sarah K, Cianciaruso Lauren B, Tracy Lloyd R
Department of Family Medicine, Eastern Division of West Virginia University, Robert C. Byrd Health Sciences Center, Harpers Ferry, West Virginia, USA.
Am Fam Physician. 2008 May 1;77(9):1255-62.
Kernicterus and neurologic sequelae caused by severe neonatal hyperbilirubinemia are preventable conditions. A structured and practical approach to the identification and care of infants with jaundice can facilitate prevention, thus decreasing rates of morbidity and mortality. Primary prevention includes ensuring adequate feeding, with breastfed infants having eight to 12 feedings per 24 hours. Secondary prevention is achieved by vigilant monitoring of neonatal jaundice, identifying infants at risk of severe hyperbilirubinemia, and ensuring timely outpatient follow-up within 24 to 72 hours of discharge. Total serum bilirubin or transcutaneous bilirubin levels should be routinely monitored in all newborns, and these measurements must be plotted on a nomogram according to the infant's age in hours. The resultant low-, intermediate-, or high-risk zones, in addition to the infant's risk factors, can guide timing of postdischarge follow-up. Another nomogram that consists of age in hours, risk factors, and total bilirubin levels can provide guidance on when to initiate phototherapy. If the infant requires phototherapy or if the bilirubin level is increasing rapidly, further work-up is indicated.
严重新生儿高胆红素血症所致的核黄疸和神经后遗症是可预防的病症。采用结构化且实用的方法来识别和护理黄疸婴儿有助于预防，从而降低发病率和死亡率。一级预防包括确保充足喂养，母乳喂养的婴儿每24小时进行8至12次喂养。二级预防通过对新生儿黄疸进行密切监测、识别有严重高胆红素血症风险的婴儿以及确保在出院后24至72小时内及时进行门诊随访来实现。应常规监测所有新生儿的总血清胆红素或经皮胆红素水平，并根据婴儿的小时龄将这些测量值绘制在列线图上。除婴儿的风险因素外，由此得出的低、中、高风险区可指导出院后随访的时间安排。另一个由小时龄、风险因素和总胆红素水平组成的列线图可为何时开始光疗提供指导。如果婴儿需要光疗或胆红素水平迅速升高，则需进一步检查。
