解读新生儿结合胆红素水平。
Interpreting conjugated bilirubin levels in newborns.
机构信息
Department of Pediatrics, California Pacific Medical Center, San Francisco, CA, USA.
出版信息
J Pediatr. 2011 Apr;158(4):562-565.e1. doi: 10.1016/j.jpeds.2010.09.061. Epub 2010 Nov 12.
OBJECTIVE
To examine the clinical significance of elevated conjugated bilirubin (CB) levels in newborns.
STUDY DESIGN
This retrospective study evaluated a birth cohort of 271 186 full-term newborns born within a Northern California hospital network from 1995 to 2004. All CB and direct bilirubin (DB) levels were available in a database and were correlated with the patients' inpatient and outpatient International Classification of Diseases, 9th Revision diagnoses.
RESULTS
The 99th percentile for CB is 0.5 mg/dL, and the 99th percentile for DB is 2.1 mg/dL. CB levels between 0.5 and 1.9 mg/dL can be associated with infection, but most often remain unexplained. Liver and biliary disease become increasingly likely as CB levels increase; for CB ≥5 mg/dL, 47% of newborns have biliary disease and 43% have liver disease.
CONCLUSIONS
CB and DB levels are not interchangeable. In newborns with CB levels ≥0.5 mg/dL and <2 mg/dL, infection must be ruled out, and the newborn should be observed. In newborns with levels ≥2 mg/dL, a more in-depth assessment of the hepatobiliary system is indicated.
目的
探讨新生儿结合胆红素（CB）水平升高的临床意义。
研究设计
本回顾性研究评估了 1995 年至 2004 年期间在加利福尼亚北部一家医院网络中出生的 271186 例足月新生儿的出生队列。所有 CB 和直接胆红素（DB）水平均在数据库中可用，并与患者的住院和门诊国际疾病分类，第 9 修订版诊断相关。
结果
CB 的第 99 百分位数为 0.5mg/dL，DB 的第 99 百分位数为 2.1mg/dL。CB 水平在 0.5 至 1.9mg/dL 之间可能与感染有关，但通常仍无法解释。随着 CB 水平的升高，肝脏和胆道疾病的可能性越来越大；对于 CB≥5mg/dL，47%的新生儿有胆道疾病，43%有肝脏疾病。
结论
CB 和 DB 水平不能互换。在 CB 水平≥0.5mg/dL 且<2mg/dL 的新生儿中，必须排除感染，并且应观察新生儿。对于 CB 水平≥2mg/dL 的新生儿，需要更深入地评估肝胆系统。
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