Morgan Melissa C, Kumar G S, Kaiser Sunitha V, Seetharam Sridevi, Ruel Theodore D
a Department of Paediatrics , University of California , San Francisco , USA.
b Departments of Paediatrics , Vivekananda Memorial Hospital , Saragur , India.
Paediatr Int Child Health. 2016 May;36(2):122-6. doi: 10.1179/2046905515Y.0000000013.
Universal pre-discharge assessment of risk for neonatal hyperbilirubinaemia is recommended by the American Academy of Pediatrics. A common algorithm is universal transcutaneous bilirubin (TcB) screening, followed by confirmatory total serum bilirubin (TSB) testing for results which cause concern. There is a paucity of data on the feasibility of TcB screening in low-income settings.
To evaluate the acceptability and feasibility of implementing universal TcB screening at a resource-limited hospital in rural India, and to determine if it was associated with increased recognition of high-risk hyperbilirubinaemia.
In December 2012 at Vivekananda Memorial Hospital, Karnataka, India, universal TcB screening at 24-48 hours of life was implemented, with TSB estimated if TcB was >75th percentile for age. The proportion of families that provided consent and the proportion of infants who underwent TcB and TSB testing were calculated. The rates of phototherapy pre- and post-implementation and the rate of high-risk hyperbilirubinaemia (TSB >95th percentile for age) post-implementation among infants ≥ 35 weeks gestation were determined.
Parents of 568 of 660 (86%) eligible infants consented to participation. All of these infants were screened with TcB. The proportion who had TSB testing was similar in the pre- (6%) and post-implementation (7%) periods. The rate of phototherapy was not significantly different after implementation (2% vs 3%). Five cases of high-risk hyperbilirubinaemia were identified post-implementation.
The study demonstrates the acceptability and feasibility of universal TcB screening at a resource-limited hospital in rural India. In settings in which early post-discharge follow-up cannot be assured, TcB can play a valuable role in identifying infants who need evaluation.
美国儿科学会建议对新生儿高胆红素血症进行普遍的出院前风险评估。一种常见的算法是进行普遍的经皮胆红素（TcB）筛查，随后对引起关注的结果进行血清总胆红素（TSB）确诊检测。关于在低收入环境中进行TcB筛查的可行性的数据很少。
评估在印度农村资源有限的医院实施普遍TcB筛查的可接受性和可行性，并确定其是否与高危高胆红素血症的识别增加有关。
2012年12月，在印度卡纳塔克邦的维韦卡南达纪念医院，对出生24 - 48小时的婴儿实施普遍TcB筛查，如果TcB高于年龄对应的第75百分位数，则估算TSB。计算提供同意的家庭比例以及接受TcB和TSB检测的婴儿比例。确定实施前后的光疗率以及孕周≥35周的婴儿实施后高危高胆红素血症（TSB高于年龄对应的第95百分位数）的发生率。
660名符合条件的婴儿中有568名（86%）的父母同意参与。所有这些婴儿都进行了TcB筛查。实施前（6%）和实施后（7%）进行TSB检测的比例相似。实施后光疗率无显著差异（2%对3%）。实施后发现5例高危高胆红素血症病例。
该研究证明了在印度农村资源有限的医院进行普遍TcB筛查的可接受性和可行性。在无法确保出院后早期随访的环境中，TcB在识别需要评估的婴儿方面可以发挥重要作用。
