Bhardwaj Kalpana, Locke Tiffany, Biringer Anne, Booth Allyson, Darling Elizabeth K, Dougan Shelley, Harrison Jane, Hill Stephen, Johnson Ana, Makin Susan, Potter Beth, Lacaze-Masmonteil Thierry, Little Julian
Children`s Hospital of Eastern Ontario Research Institute - BORN Ontario, Ottawa, Ontario. Canada.
University of Toronto, Mount Sinai Hospital and Family and Community Medicine - Ray D Wolfe Department of Family Medicine, Toronto, Ontario. Canada.
Curr Pediatr Rev. 2017;13(1):67-90. doi: 10.2174/1573396313666170110144345.
According to the 2004 American Academy of Pediatrics guideline on the management of hyperbilirubinemia, every newborn should be assessed for the risk of developing severe hyperbilirubinemia with the help of predischarge total serum bilirubin or transcutaneous bilirubin measurements and/or assessments of clinical risk factors. The aim of this rapid review is 1) to review the evidence for 1) predicting and preventing severe hyperbilirubinemia and bilirubin encephalopathy, 2) determining the efficacy of home/community treatments (home phototherapy) in the prevention of severe hyperbilirubinemia, and 3) non-invasive/transcutaneous methods for estimating serum bilirubin level.
In this rapid review, studies were identified through the Medline database. The main outcomes of interest were severe hyperbilirubinemia and encephalopathy. A subset of articles was double screened and all articles were critically appraised using the SIGN and AMSTAR checklists. This review investigated if systems approach is likely to reduce the occurrence of severe hyperbilirubinemia.
Fifty-two studies met the inclusion criteria. Included studies assessed the association between bilirubin measurement early in neonatal life and the subsequent development of severe hyperbilirubinemia and chronic bilirubin encephalopathy/kernicterus. It was observed that, highest priority should be given to (i) universal bilirubin screening programs; (ii) implementation of community and midwife practice; (iii) outreach to communities for education of prospective parents; and (iv) development of clinical pathways to monitor, evaluate and track infants with severe hyperbilirubinemia.
We found substantial observational evidence that severe hyperbilirubinemia can be accurately predicted and prevented through universal bilirubin screening. So far, there is no evidence of any harm.
根据2004年美国儿科学会关于高胆红素血症管理的指南，应借助出院前总血清胆红素或经皮胆红素测量和/或临床风险因素评估，对每例新生儿进行严重高胆红素血症发生风险的评估。本快速综述的目的是：1）回顾关于预测和预防严重高胆红素血症及胆红素脑病的证据；2）确定家庭/社区治疗（家庭光疗）在预防严重高胆红素血症方面的疗效；3）评估非侵入性/经皮方法估算血清胆红素水平的情况。
在本快速综述中，通过Medline数据库检索研究。主要关注的结果是严重高胆红素血症和脑病。对一部分文章进行了双重筛选，所有文章均使用SIGN和AMSTAR清单进行严格评估。本综述调查了系统方法是否可能减少严重高胆红素血症的发生。
52项研究符合纳入标准。纳入的研究评估了新生儿早期胆红素测量与随后严重高胆红素血症及慢性胆红素脑病/核黄疸发生之间的关联。结果发现，应将最高优先级给予：（i）普遍的胆红素筛查项目；（ii）社区和助产士实践的实施；（iii）深入社区对准父母进行教育；（iv）制定临床路径以监测、评估和跟踪患有严重高胆红素血症的婴儿。
我们发现大量观察性证据表明，通过普遍的胆红素筛查可以准确预测和预防严重高胆红素血症。到目前为止，没有任何危害的证据。
