Cortey A, Renesme L, Raignoux J, Bedu A, Casper C, Tourneux P, Truffert P
Unité fonctionnelle clinique du centre national de référence en hémobiologie périnatale (CNRHP), service de médecine fœtale, pôle périnatalité du GHU Est-Parisien, hôpital Trousseau, AP-HP, 26, avenue Arnold-Netter, 75012 Paris, France.
Néonatologie maternité, centre Aliénor-d'Aquitaine, CHU de Bordeaux, place Amélie- Raba- Léon, 33076 Bordeaux cedex, France.
Arch Pediatr. 2017 Feb;24(2):192-203. doi: 10.1016/j.arcped.2016.11.011. Epub 2017 Jan 14.
Jaundice due to unconjugated bilirubin is an everyday condition in the neonatal period because it results from the adaptation of bilirubin metabolism at this time of life. Hyperbilirubinemia has a potential neurotoxicity and although it most often resolves spontaneously, it can lead to acute and sometimes chronic encephalopathy. The latter condition is called kernicterus and induces severe and irreversible neurological sequelae. This rare complication is still reported in all countries throughout the world even if severe hyperbilirubinemia can be prevented and critical points points of failure in jaundice management are identified. Jaundice management are identified, jaundice is the most frequent symptom during the first days of life and after discharge from the maternity ward but also the major cause of readmission in the 15 first days of life. Therefore in the past 20 years, numerous countries have written national practical guidelines for the management of neonatal jaundice using various methodologies. Most of the time, the guidelines resulted from expert consensus more than from an evidence-based argument. The Société française de néonatologie created a working group to provide the first French clinical guidelines for the management of jaundice in the near-term newborn (35 weeks and more). They were written following a physiopathological argument and taking into account both clinical risk factors for severe hyperbilirubinemia and interindividual variability in vulnerability to bilirubin neurotoxicity. Practical tools were also developed to facilitate implementation of the guidelines and are also included.
由于未结合胆红素引起的黄疸在新生儿期是一种常见情况,因为它是生命这个阶段胆红素代谢适应的结果。高胆红素血症具有潜在的神经毒性,尽管它大多时候会自发消退,但可能导致急性甚至有时是慢性脑病。后一种情况称为核黄疸,会引发严重且不可逆的神经后遗症。即使严重高胆红素血症可以预防且黄疸管理中的关键失败点已被识别,这种罕见并发症在世界各国仍有报道。黄疸是出生后头几天以及从产科病房出院后最常见的症状,也是出生后15天内再次入院的主要原因。因此,在过去20年里,许多国家使用各种方法制定了新生儿黄疸管理的国家实用指南。大多数情况下,这些指南源于专家共识而非基于证据的论证。法国新生儿学会成立了一个工作组,以提供第一份法国近期新生儿(35周及以上)黄疸管理的临床指南。这些指南是基于病理生理学论证编写的,同时考虑了严重高胆红素血症的临床风险因素以及个体对胆红素神经毒性易感性的个体差异。还开发了实用工具以促进指南的实施,并且也包含在内。