Division of Perinatal Medicine, Policlinico Abano Terme, Piazza Colombo 1, 35031, Abano Terme, Italy.
Division of Social Statistics and Demography, University of Southampton, Southampton, UK.
Ital J Pediatr. 2017 Aug 4;43(1):67. doi: 10.1186/s13052-017-0382-8.
The recognition, follow-up, and early treatment of neonatal jaundice has become more difficult, since the earlier discharge of newborns from hospitals has become common practice. Since intrapartum hypoxic stress has been pointed as predisposing factor for the occurrence of hyperbilirubinemia risk, we tested the association with the cord blood acid-base index tests.
A cohort of healthy term and near-term newborns underwent umbilical cord hemogasanalysis at birth and capillary heel total serum bilirubin (TSB) pre-discharge, scheduled at 36 h of life, to define the risk of significant hyperbilirubinemia, defined as >9 mg/dL TSB level, ≥ 75th percentile on nomogram of Bhutani et al.
It was found that among 537 studied neonates, 133 (24.8%) had pre-discharge TSB levels of >9 mg/dL. When the cord blood gas analysis index tests were compared, their acidemia levels were significantly higher than those of neonates with normal TSB levels: HCO (20.71 ± 2.37 vs. 21.29 ± 2.25 mEq/L, p < 0.010), base deficit (-3.52 ± 3.188 vs. -2.68 ± 3.266 mEq/L, p < 0.010), and lactacidemia (3.84 ± 1.864 vs. 3.39 ± 1.737 mEq/L, p < 0.012), respectively. However, logistic regression analysis showed that base deficit was the strongest index of the pre-discharge hyperbilirubinemia risk (OR, 95% CI 0.593; 0.411-0.856), and the hyperbilirubinemia risk increased by 40% with the decrease of 1 mEq/L of base deficit.
Umbilical cord blood acidemia and lactacidemia are significant indexes of adaptive mechanisms at birth. The base deficit provides the strongest association with future development of high bilirubin on an hour specific bilirubin nomogram generating risk stratification score in term and near-term neonates.
由于新生儿提前出院已成为常见做法，新生儿黄疸的识别、随访和早期治疗变得更加困难。由于产时缺氧应激已被认为是胆红素血症风险发生的易患因素，我们检测了其与脐血酸碱指数测试的相关性。
一组健康的足月和近足月新生儿在出生时进行脐动脉血气分析，并在出生后 36 小时内进行毛细血管足跟总血清胆红素（TSB）预检测，以确定高胆红素血症的风险，定义为 TSB 水平>9mg/dL，Bhutani 等的列线图中>75%的百分位。
在 537 例研究的新生儿中，有 133 例（24.8%）在出院前 TSB 水平>9mg/dL。当比较脐血气体分析指标测试时，他们的酸中毒水平明显高于 TSB 水平正常的新生儿：HCO3（20.71±2.37 与 21.29±2.25 mEq/L，p<0.010），碱缺乏（-3.52±3.188 与-2.68±3.266 mEq/L，p<0.010）和乳酸性血症（3.84±1.864 与 3.39±1.737 mEq/L，p<0.012）。然而，逻辑回归分析显示，碱缺乏是出院前高胆红素血症风险的最强指标（OR，95%CI 0.593；0.411-0.856），碱缺乏每降低 1mEq/L，高胆红素血症风险增加 40%。
脐血酸中毒和乳酸性血症是出生时适应机制的重要指标。在足月和近足月新生儿的特定胆红素小时胆红素列线图中，碱缺乏值与高胆红素的发生具有最强的相关性，并产生风险分层评分。
