新生儿胆汁淤积性黄疸的早期诊断：2 周时检测。
Early diagnosis of neonatal cholestatic jaundice: test at 2 weeks.
机构信息
Division of Gastroenterology, Hepatology and Nutrition at Hospital for Sick Children,Toronto, Ont.
出版信息
Can Fam Physician. 2009 Dec;55(12):1184-92.
OBJECTIVE
To review best practices for early recognition and treatment of conditions resulting in neonatal cholestasis, in order to improve long-term outcomes for affected infants.
QUALITY OF EVIDENCE
Studies, review articles, and meta-analyses pertaining to neonatal-onset cholestasis were sought via electronic databases. Reference lists of studies and review articles supplemented the electronic search. Studies were included if they examined the importance of early diagnosis and intervention for cholestatic jaundice of any cause, and mainly comprised Level II and Level III evidence.
MAIN MESSAGE
Review of the relevant literature supports the recommendation that infants with jaundice at 2 weeks of age should be tested for cholestasis by quantifying the direct reacting bilirubin levels in their blood. Subsequent rapid investigation using a diagnostic algorithm enables early diagnosis of the specific cause and facilitates timely intervention for conditions whose outcomes are improved by early treatment.
CONCLUSION
Universal screening for neonatal cholestasis might help with early identification of cases and improve outcomes, although further study is required in the North American setting.
目的
回顾关于早期识别和治疗导致新生儿胆汁淤积的各种病症的最佳实践，以改善受累婴儿的长期预后。
证据质量
通过电子数据库搜索与新生儿胆汁淤积相关的研究、综述文章和荟萃分析。此外，还通过查阅研究和综述文章的参考文献列表来补充电子检索。如果研究检查了任何病因的胆汁淤积性黄疸的早期诊断和干预的重要性，并且主要包含 II 级和 III 级证据，则将这些研究纳入。
主要信息
对相关文献的回顾支持以下建议，即对于 2 周龄时出现黄疸的婴儿，应通过定量检测其血液中的直接反应胆红素水平来检测胆汁淤积。随后使用诊断算法进行快速调查，可以早期诊断出特定病因，并及时干预那些通过早期治疗可改善预后的病症。
结论
虽然在北美环境中还需要进一步研究，但普遍筛查新生儿胆汁淤积症可能有助于早期发现病例并改善预后。
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