Schutzman David L, Sekhon Romal, Hundalani Shilpa
Division of Neonatology, Department of Pediatrics, Albert Einstein Medical Center, Philadelphia, PA 19141, USA.
Arch Pediatr Adolesc Med. 2010 Dec;164(12):1158-64. doi: 10.1001/archpediatrics.2010.242.
To determine the usefulness of the hour-specific Bhutani et al bilirubin nomogram when applied to infants with Coombs-positive test results.
Retrospective chart review.
Term nursery and neonatal intensive care unit of a university-affiliated hospital.
All infants with A+ or B+ blood type born in our center from September 1, 2006, through August 31, 2008, to mothers with O+ blood.
Proportion of infants with Coombs-positive results from the nomogram zones who required phototherapy and comparison of the percentage of infants with Coombs-positive results in each zone with the percentage of those with Coombs-negative results in each zone.
A total of 240 infants with Coombs-positive and 460 with Coombs-negative results having a gestational age of 35 weeks or older were evaluated. Sensitivity and specificity of data for infants with direct Coombs-positive results in zone 4 (high risk; 74.2% and 97.1%) and those for infants in zones 3 (high-intermediate risk) and 4 combined (96.7% and 83.7%) compared favorably with the data from the Bhutani et al cohort, which had direct Coombs-negative results (54.0% and 96.2% for zone 4; 90.5% and 84.7% for zones 3 and 4 combined). The likelihood ratio for infants with direct Coombs-positive results in zone 4, 25.8 (95% confidence interval, 11.4-58.4), was twice that of the Bhutani et al cohort, 14.1 (11.0-18.1). The nomogram performed well in directing the timing of bilirubin level follow-up. All infants in zones 3 and 4 with Coombs-positive results were followed up after hospital discharge. None required an exchange transfusion or developed bilirubin encephalopathy.
The Bhutani et al bilirubin nomogram reliably identified infants at gestational age of older than 35 weeks with direct Coombs-positive results who were at risk for significant hyperbilirubinemia and directed the timing of follow-up for these infants. This finding has direct clinical applicability to the health care professional practicing in the newborn nursery.
确定特定时间的布塔尼等人的胆红素列线图应用于库姆斯试验结果呈阳性的婴儿时的实用性。
回顾性图表审查。
大学附属医院的足月儿 nursery 和新生儿重症监护病房。
2006年9月1日至2008年8月31日在我们中心出生的所有血型为A+或B+、母亲血型为O+的婴儿。
来自列线图区域的库姆斯试验结果呈阳性且需要光疗的婴儿比例，以及每个区域库姆斯试验结果呈阳性的婴儿百分比与每个区域库姆斯试验结果呈阴性的婴儿百分比的比较。
共评估了240例库姆斯试验结果呈阳性且胎龄≥35周的婴儿和460例库姆斯试验结果呈阴性的婴儿。与布塔尼等人队列中库姆斯试验结果呈阴性的数据（第4区为54.0%和96.2%；第3区和第4区合并为90.5%和84.7%）相比，第4区（高风险；74.2%和97.1%）直接库姆斯试验结果呈阳性的婴儿以及第3区（高中等风险）和第4区合并的婴儿的数据的敏感性和特异性表现良好。第4区直接库姆斯试验结果呈阳性的婴儿的似然比为25.8（95%置信区间，11.4 - 58.4），是布塔尼等人队列的两倍，为14.1（11.0 - 18.1）。该列线图在指导胆红素水平随访时间方面表现良好。第3区和第4区所有库姆斯试验结果呈阳性的婴儿在出院后均接受了随访。无人需要换血治疗或发生胆红素脑病。
布塔尼等人的胆红素列线图能够可靠地识别胎龄大于35周、直接库姆斯试验结果呈阳性且有显著高胆红素血症风险的婴儿，并指导这些婴儿的随访时间。这一发现对新生儿 nursery 的医护人员具有直接的临床适用性。
