对因高胆红素血症需要光疗的新生儿进行推荐血液检查的结果。

Besser Itay, Perry Zvi H, Mesner Oded, Zmora Ehud, Toker Asaf

Department of Neonatology, Soroka University Medical Center, Beer Sheva, Israel.

Isr Med Assoc J. 2010 Apr;12(4):220-4.

BACKGROUND

Hyperbilirubinemia of the newborn is common. Rarely is an underlying disease other than physiologic hyperbilirubinemia considered the cause of high bilirubin levels. Some of the laboratory tests recommended by the American Academy of Pediatrics are expensive and do not always lead to diagnosis.

OBJECTIVE

To evaluate the efficacy of standard laboratory tests performed on newborn infants requiring phototherapy for hyperbilirubinaemia.

METHODS

We conducted a retrospective chart review that included neonates born during a 6 month period with birth weight 2500 g treated with phototherapy for hyperbilirubinemia (n = 282) according to published guidelines. The main outcome measures were primary and maximal bilirubin values (mg/dl), time to jaundice (in days), the number of bilirubin tests undertaken and whether the patient showed abnormal functioning, and the number of days in follow-up.

RESULTS

Thirty-three neonates (11.7%) were positive in at least one laboratory test (defined as "Abnormal" in our study), 45.5% of whom met the criteria for phototherapy during the first 48 hours of life. Among the newborns who were negative for all laboratory tests (defined as "Normal"), only 6.8% met phototherapy criteria within their first 48 hours of life (P < 0.001). In the Normal group there was a consistent decrease in total serum bilirubin values shortly after phototherapy was begun, while the Abnormal group presented an increase in serum bilirubin values during the first 12 hours of phototherapy. None of the infants had conjugated (direct) hyperbilirubinemia during the study period.

CONCLUSIONS

Most neonates presenting with a laboratory identifiable etiology for hyperbilirubinemia (i.e., hemolysis) can be distinguished from those who test negative, mainly based on the timing of presentation and response to phototherapy. A more meticulous selection of patients and reduction in the magnitude of routine laboratory testing can safely reduce discomfort to infants with hyperbilirubinemia as well as costs.

背景

新生儿高胆红素血症很常见。除生理性高胆红素血症外，很少有其他潜在疾病被认为是高胆红素水平的病因。美国儿科学会推荐的一些实验室检查费用昂贵，且并不总能得出诊断结果。

目的

评估对因高胆红素血症需要光疗的新生儿进行标准实验室检查的效果。

方法

我们进行了一项回顾性病历审查，纳入了根据已发表指南在6个月期间出生、出生体重≥2500 g且因高胆红素血症接受光疗的新生儿（n = 282）。主要观察指标为初始和最高胆红素值（mg/dl）、黄疸出现时间（天）、进行胆红素检查的次数以及患者是否存在功能异常，还有随访天数。

结果

33例新生儿（11.7%）至少一项实验室检查呈阳性（在我们的研究中定义为“异常”），其中45.5%在出生后48小时内符合光疗标准。在所有实验室检查均为阴性的新生儿（定义为“正常”）中，只有6.8%在出生后48小时内符合光疗标准（P < 0.001）。在正常组中，光疗开始后不久总血清胆红素值持续下降，而异常组在光疗的前12小时内血清胆红素值升高。在研究期间，没有婴儿出现结合（直接）胆红素血症。