Bhutani V K, Wong R J, Vreman H J, Stevenson D K
Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.
J Perinatol. 2015 Sep;35(9):735-8. doi: 10.1038/jp.2015.32. Epub 2015 Apr 16.
We assessed the relative contributions of increased bilirubin production (indexed by end-tidal carbon monoxide (CO) concentrations, corrected for ambient CO (ETCOc)) to hour-specific total bilirubin (TB) levels in healthy late preterm and term newborns.
Post hoc analyses of concurrent ETCOc and TB (at 30±6 h of age) and follow-up TB levels at age 96±12 h and up to 168 h after birth were performed in a cohort of 641 term and late preterm infants.
Increased bilirubin production (hour-specific ETCOc ⩾1.7 p.p.m. at age 30±6 h) was noted in ~80%, 42% and 32% of infants in the high-, intermediate- and low-risk TB zones, respectively. One infant with TB <40th percentile and ETCOc <1.7 p.p.m. developed TB ⩾95th percentile at age 168 h, probably due to decreased bilirubin elimination.
Infants in the high-risk quartile of the hour-specific bilirubin nomogram have a higher mean bilirubin production. Infants with TB levels ⩾95th percentile without increased bilirubin production have impaired bilirubin elimination.
我们评估了健康晚期早产儿和足月儿中胆红素生成增加（以经环境一氧化碳校正的潮气末一氧化碳（CO）浓度为指标，即ETCOc）对特定时间点总胆红素（TB）水平的相对贡献。
对641名足月儿和晚期早产儿队列进行了事后分析，测量了出生后30±6小时的ETCOc和TB，以及96±12小时至168小时的随访TB水平。
在高、中、低风险TB区域中，分别约80%、42%和32%的婴儿出现胆红素生成增加（30±6小时时特定时间点的ETCOc⩾1.7ppm）。一名TB处于第40百分位数以下且ETCOc<1.7ppm的婴儿在168小时时TB⩾第95百分位数，可能是由于胆红素清除减少所致。
特定时间点胆红素列线图高风险四分位数的婴儿平均胆红素生成较高。TB水平⩾第95百分位数且胆红素生成未增加的婴儿存在胆红素清除受损。
