Kuzniewicz Michael W, Escobar Gabriel J, Newman Thomas B
Division of Neonatology, Department of Pediatrics, University of California, San Francisco, CA 94143-0748, USA.
Pediatrics. 2009 Oct;124(4):1031-9. doi: 10.1542/peds.2008-2980. Epub 2009 Sep 28.
The goal was to assess the impact of universal bilirubin screening on severe hyperbilirubinemia and phototherapy use.
In this retrospective cohort study of 358086 infants of > or =35 weeks and > or =2000 g born between January 1, 1995, and June 30, 2007, we obtained demographic data, bilirubin levels, and codes for inpatient phototherapy from existing databases. We compared the incidence of high total serum bilirubin (TSB) levels and phototherapy before and after implementation of universal screening and examined risk factors for high TSB levels.
A total of 38182 infants (10.6%) were born at facilities that had implemented universal bilirubin screening. Compared with infants born at facilities that were not screening, these infants had a 62% lower incidence of TSB levels exceeding the American Academy of Pediatrics exchange guideline (0.17% vs 0.45%; P < .001), received twice the inpatient phototherapy (9.1% vs 4.2%; P < .001), and had slightly longer birth hospitalization lengths of stay (50.9 vs 48.7 hours; P < .001). Of those receiving phototherapy, 56% after initiation of universal screening had TSB levels at which phototherapy was recommended by the guideline, compared with 70% before screening. The adjusted odds ratio for developing TSB levels exceeding the guideline value was 0.28 (95% confidence interval: 0.20-0.40) for those born at a facility using TSB screening and 0.28 (95% confidence interval: 0.19-0.42) for those born at a facility using transcutaneous bilirubin screening.
Universal bilirubin screening was associated with a significantly lower incidence of severe hyperbilirubinemia but also with increased phototherapy use.
评估普遍胆红素筛查对严重高胆红素血症及光疗使用情况的影响。
在这项回顾性队列研究中，纳入了1995年1月1日至2007年6月30日期间出生的358086名孕周≥35周且出生体重≥2000克的婴儿，我们从现有数据库中获取了人口统计学数据、胆红素水平以及住院光疗编码。我们比较了普遍筛查实施前后总血清胆红素（TSB）高水平及光疗的发生率，并检查了TSB高水平的危险因素。
共有38182名婴儿（10.6%）在已实施普遍胆红素筛查的机构出生。与未进行筛查机构出生的婴儿相比，这些婴儿TSB水平超过美国儿科学会换血指南的发生率低62%（0.17%对0.45%；P<.001），接受住院光疗的比例为未筛查机构出生婴儿的两倍（9.1%对4.2%；P<.001），且出生后住院时间略长（50.9小时对48.7小时；P<.001）。在接受光疗的婴儿中，普遍筛查开始后，56%的婴儿TSB水平处于指南推荐光疗的范围，而筛查前这一比例为70%。对于在使用TSB筛查的机构出生的婴儿，发生TSB水平超过指南值的校正比值比为0.28（95%置信区间：0.20 - 0.40），对于在使用经皮胆红素筛查的机构出生的婴儿，这一比值比为0.28（95%置信区间：0.19 - 0.42）。
普遍胆红素筛查与严重高胆红素血症的发生率显著降低相关，但也与光疗使用的增加有关。
