Division of General Pediatrics, Pediatrics Department, Hospital São João, Porto, Portugal.
Pediatrics. 2011 Jan;127(1):e126-31. doi: 10.1542/peds.2009-2771. Epub 2010 Dec 13.
Our aim was to validate a strategy for assessing the risk of significant hyperbilirubinemia in newborns with gestational ages of ≥35 weeks by combining predischarge bilirubin percentile data with gestational age data, for a European, predominantly white population.
We conducted a prospective cohort study with 463 newborns with gestational ages of ≥35 weeks who were admitted to the well-infant nursery. Total bilirubin levels were measured daily until discharge and once after discharge, between the third and eighth days of life, by using a Bilicheck device (Respironics, Murrysville, PA). The values obtained (<52 hours) were plotted on an hour-specific bilirubin nomogram to determine the infant's bilirubin percentile, expressed as a risk zone. Patients were assigned to 1 of 3 risk groups (very low, low, or high) on the basis of a combination of risk zone and gestational age data and were monitored prospectively for the development of significant hyperbilirubinemia. The 95% confidence interval (CI) for the prevalence of significant hyperbilirubinemia was estimated with the binomial distribution method.
Forty-four infants (11%) developed significant neonatal hyperbilirubinemia. The risks of developing significant hyperbilirubinemia were 1.3% (95% CI: 0.2%-3.7%) for the very low risk group (n = 230 [58.1%]), 3.4% (95% CI: 0.7%-9.8%) for the low risk group (n = 86 [21.7%]), and 47.50% (95% CI: 36.2%-59.0%) for the high risk group (n = 80 [20.20%]).
The proposed strategy, based on predischarge bilirubin level and gestational age data, was a valid method for significant hyperbilirubinemia risk assessment in our population.
我们旨在通过结合早产儿胆红素百分位数据和胎龄数据，为欧洲主要是白人的人群验证一种评估胎龄≥35 周新生儿发生显著高胆红素血症风险的策略。
我们进行了一项前瞻性队列研究，纳入了 463 名胎龄≥35 周的新生儿，这些新生儿被收入新生儿重症监护室。在住院期间，每天测量总胆红素水平，直至出院后第 3 至第 8 天，使用 Bilicheck 设备（Respironics，Murrysville，PA）测量一次。在特定时间的胆红素百分位图上绘制获得的胆红素值（<52 小时），以确定婴儿的胆红素百分位，并用风险区域表示。根据风险区域和胎龄数据的组合，将患者分为 3 个风险组（极低、低或高），并对其进行前瞻性监测，以确定是否发生显著高胆红素血症。使用二项式分布方法估计显著高胆红素血症的 95%置信区间（CI）。
44 名婴儿（11%）发生了显著的新生儿高胆红素血症。极低风险组（n=230[58.1%]）发生显著高胆红素血症的风险为 1.3%（95%CI：0.2%-3.7%），低风险组（n=86[21.7%]）为 3.4%（95%CI：0.7%-9.8%），高风险组（n=80[20.2%]）为 47.50%（95%CI：36.2%-59.0%）。
基于出院前胆红素水平和胎龄数据的提出的策略是评估我们人群中显著高胆红素血症风险的有效方法。
