Calkins K, Roy D, Molchan L, Bradley L, Grogan T, Elashoff D, Walker V
Department of Pediatrics, Division of Neonatology and Developmental Biology, Neonatal Research Center, David Geffen School of Medicine, University of California, and Mattel Children's Hospital at UCLA, Los Angeles, CA, USA.
Department of Medicine, Statistics Core, David Geffen School of Medicine, University of California and Mattel Children's Hospital at UCLA, Los Angeles, CA, USA.
J Neonatal Perinatal Med. 2015;8(3):243-50. doi: 10.3233/NPM-15814111.
To determine the predictive ability of cord blood bilirubin (CBB) for hyperbilirubinemia in a population at risk for maternal-fetal blood group incompatibility and hemolytic disease of the newborn.
This is a single center retrospective case-control study. Cases received phototherapy; controls did not. Cases were matched 1:3 to controls by gender and treating physician. Inclusion criteria included: ≥35 weeks gestation, CBB, and one or more total serum bilirubin (TSB) concentrations. The primary outcome was CBB. Secondary outcomes were a TSB >75th percentile, length of stay, and neonatal intensive care unit admission. The prognostic ability of CBB for phototherapy and TSB >75th percentile was assessed using area under the receiver operating characteristic (ROC) curve. Logistic regression analyses were performed to determine predictors for phototherapy and TSB >75th percentile.
When compared to controls (n = 142), cases (n = 54) were more likely to have a positive Coombs' test (82% vs. 41% , p < 0.001) and TSB >75th percentile (85% vs. 21% , p < 0.001). When compared to controls, cases had a higher mean (±SD) CBB (2.5 ± 0.5 vs. 1.8 ± 0.4 mg/dL, p < 0.001). The area under the ROC curve (±SEM) for CBB for phototherapy and TSB >75th percentile was 0.87 ± 0.03 (p < 0.001, 95% CI 0.82, 0.93) and 0.87 ± 0.03 (p < 0.001, 95% CI 0.82, 0.92), respectively.
In this study, the mean CBB concentration was higher in neonates who received phototherapy compared to those who did not. CBB concentrations may help predict severe hyperbilirubinemia and phototherapy in a population at risk for hemolytic disease of the newborn.
确定脐血胆红素（CBB）对母婴血型不合和新生儿溶血病高危人群高胆红素血症的预测能力。
这是一项单中心回顾性病例对照研究。病例接受光疗；对照未接受光疗。病例按性别和治疗医生与对照以1:3进行匹配。纳入标准包括：妊娠≥35周、CBB以及一个或多个总血清胆红素（TSB）浓度。主要结局是CBB。次要结局是TSB>第75百分位数、住院时间和新生儿重症监护病房入院情况。使用受试者操作特征（ROC）曲线下面积评估CBB对光疗和TSB>第75百分位数的预测能力。进行逻辑回归分析以确定光疗和TSB>第75百分位数的预测因素。
与对照（n = 142）相比，病例（n = 54）更可能抗人球蛋白试验呈阳性（82%对41%，p < 0.001）且TSB>第75百分位数（85%对21%，p < 0.001）。与对照相比，病例的平均（±标准差）CBB更高（2.5±0.5对1.8±0.4mg/dL，p < 0.001）。CBB对光疗和TSB>第75百分位数的ROC曲线下面积（±标准误）分别为0.87±0.03（p < 0.001，95%可信区间0.82，0.93）和0.87±0.03（p < 0.001，95%可信区间0.82，0.92）。
在本研究中，接受光疗的新生儿的平均CBB浓度高于未接受光疗的新生儿。CBB浓度可能有助于预测新生儿溶血病高危人群的严重高胆红素血症和光疗情况。
