Department of Pediatrics, University Hospital of Patras, Rio, Patras, 265 04, Greece.
Pediatrics. 2012 Oct;130(4):e898-904. doi: 10.1542/peds.2012-0732. Epub 2012 Sep 10.
To provide data on the natural course of transcutaneous bilirubin (TcB) levels in neonates before the development of significant hyperbilirubinemia, and to assess the effect of different demographic and perinatal factors on the rate of TcB increase.
We analyzed 2454 TcB measurements from 419 neonates before the development of significant hyperbilirubinemia. Mean TcB values and TcB percentiles for designated times were calculated, and the effect of different risk factors on the rate of TcB increase was assessed. TcB percentile curves were plotted for comparison on a population-based TcB nomogram.
Blood incompatibilities and glucose-6-phosphate dehy-drogenase deficiency were associated with higher rates of TcB in-crease during the first 36 to 48 postnatal hours, whereas smaller gestational age, increased weight loss, and exclusive breastfeeding had a similar but later effect. Compared with general population norms, a different pattern of TcB increase was noted in neonates who developed significant hyperbilirubinemia, but with a sub-stantial overlap of TcB values during the first 24 to 48 postnatal hours.
We provide data on the natural course of TcB levels before the development of significant hyperbilirubinemia in a white population of term and near-term neonates. Smaller gestational age, blood incompatibilities, glucose-6-phosphate dehydrogenase deficiency, increased weight loss, and exclusive breastfeeding significantly affected the rate of TcB increase in a time-dependent manner. These findings may assist in assessing the risk for significant hyperbilirubinemia and planning appropriate follow-up strategies for neonates with borderline bilirubin levels.
提供新生儿在出现显著高胆红素血症之前经皮胆红素（TcB）水平自然变化的数据，并评估不同人口统计学和围产期因素对 TcB 升高率的影响。
我们分析了 419 例新生儿在出现显著高胆红素血症前的 2454 次 TcB 测量值。计算了指定时间的平均 TcB 值和 TcB 百分位数，并评估了不同危险因素对 TcB 升高率的影响。绘制了 TcB 百分位曲线，以便在基于人群的 TcB 列线图上进行比较。
血液不相容和葡萄糖-6-磷酸脱氢酶缺乏与出生后前 36 至 48 小时 TcB 升高率较高相关，而较小的胎龄、体重减轻增加和纯母乳喂养则具有相似但较晚的影响。与一般人群的正常值相比，出现显著高胆红素血症的新生儿 TcB 升高模式不同，但在前 24 至 48 小时出生后 TcB 值有很大的重叠。
我们提供了白种人群足月和近足月新生儿在出现显著高胆红素血症前 TcB 水平自然变化的数据。较小的胎龄、血液不相容、葡萄糖-6-磷酸脱氢酶缺乏、体重减轻增加和纯母乳喂养以时间依赖的方式显著影响 TcB 升高率。这些发现可能有助于评估显著高胆红素血症的风险，并为胆红素水平接近临界值的新生儿制定适当的随访策略。
