Division of Neonatology, Casilino General Hospital, ASL RM-B, Rome, Italy.
Eur J Pediatr. 2009 Sep;168(9):1025-30. doi: 10.1007/s00431-009-0969-1. Epub 2009 Mar 11.
Early discharge from the maternity hospital is almost becoming the rule: it is not clear if this practice actually increases the rate of newborn rehospitalization, but it surely poses some problems for jaundice management, since hyperbilirubinemia is the most frequent reason for hospital readmission. Available guidelines for jaundice management and early discharge are reviewed. Evidence-based update is given about four new points: use of gestational age as predictor jointly with the nomogram evaluation, two-point bilirubin assay, and rate of rise evaluation; choice of the "right" curve and unforeseen jaundice risk factors. In conclusion, available predictive tools allow reliable jaundice prediction and safe early discharge if adequate follow-up is planned according to the prediction. Advice about things to avoid is provided together with a practical flowchart based on guidelines and recent evidence-based data.
目前尚不清楚这种做法实际上是否会增加新生儿再次住院的比率，但它确实给黄疸管理带来了一些问题，因为高胆红素血症是医院再次入院的最常见原因。对黄疸管理和提前出院的现有指南进行了回顾。对以下四个新要点提供了循证更新：将胎龄用作预测指标并与图表评估、两点胆红素检测和上升率评估结合使用；选择“正确”的曲线和不可预见的黄疸危险因素。总之，如果根据预测进行了充分的随访，现有的预测工具可实现可靠的黄疸预测和安全的提前出院。同时还提供了有关应避免事项的建议，并根据指南和最新的循证数据制定了一个实用的流程图。
