Dijk Peter H, de Vries Tjalling W, de Beer J J A Hans
Universitair Medisch Centrum Groningen, Beatrix Kinderziekenhuis, afd. Kindergeneeskunde, Groningen, The Netherlands.
Ned Tijdschr Geneeskd. 2009;153:A93.
Bilirubin encephalopathy and kernicterus are preventable conditions. Nevertheless cases continue to occur. It is difficult to identify those infants who may develop severe hyperbilirubinemia, because icterus neonatorum occurs in most newborns. The aim of this guideline is to reduce the incidence of severe neonatal hyperbilirubinemia and bilirubin encephalopathy, and at the same time to minimise the risk of unintended side effects. At the initiative of the Dutch Pediatric Association and with methodological support from the Dutch Institute for Healthcare Improvement (CBO), a multidisciplinary working group adapted the clinical practice guideline on hyperbilirubinemia of the American Academy of Pediatrics (AAP) to the Dutch situation. This guideline provides recommendations for the prevention, diagnosis and treatment of hyperbilirubinemia in neonates (>or= 35 weeks). For all newborns a risk assessment for the development of hyperbilirubinemia is made and they are to be systematically assessed during the first week of life. The guideline provides various intervention thresholds for risk groups, recommendations for the use of intravenous immunoglobulin in the event of severe hyperbilirubinemia on the basis of blood group antagonisms, and recommendations for conjugated hyperbilirubinemia. During the transfer of care, information about the risk factors in particular must be satisfactorily passed on.
胆红素脑病和核黄疸是可预防的病症。然而，病例仍在不断出现。由于大多数新生儿都会出现新生儿黄疸，因此很难识别那些可能会发展为严重高胆红素血症的婴儿。本指南的目的是降低严重新生儿高胆红素血症和胆红素脑病的发病率，同时将意外副作用的风险降至最低。在荷兰儿科学会的倡议下，并在荷兰医疗保健改进研究所（CBO）的方法学支持下，一个多学科工作组根据荷兰的情况对美国儿科学会（AAP）的高胆红素血症临床实践指南进行了调整。本指南为新生儿（≥35周）高胆红素血症的预防、诊断和治疗提供了建议。对所有新生儿进行高胆红素血症发生风险评估，并在其出生后第一周内进行系统评估。该指南为风险群体提供了各种干预阈值，针对基于血型拮抗作用出现严重高胆红素血症时使用静脉注射免疫球蛋白给出了建议，还给出了结合胆红素血症的相关建议。在护理交接过程中，尤其必须妥善传递有关风险因素的信息。
