Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.
Department of Pediatrics, Beaumont Children's and Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA.
Acta Paediatr. 2018 Aug;107(8):1350-1356. doi: 10.1111/apa.14316. Epub 2018 Apr 16.
To identify neonates at risk of haemolytic hyperbilirubinaemia through near-concurrent measurements of total serum/plasma bilirubin (TB) or transcutaneous bilirubin (TcB) and end-tidal breath carbon monoxide (CO), corrected for ambient CO (ETCOc), an index of bilirubin production and haemolysis.
Paired TB/TcB (mg/dL) and ETCOc (ppm) measurements were obtained in newborns (n = 283) at 20 to <60 hours of age in five nurseries. TB/TcB values were assigned TB/TcB percentile risk values using the Bhutani hour-specific nomogram. In infants having two serial TB/TcB measurements (n = 76), TB rate of rise (ROR, mg/dL/h) was calculated.
For the entire cohort (n = 283), 67.1% and 32.9% had TB/TcB<75th and ≥75th percentile, respectively. TB/TcB (5.79 ± 1.84 vs 9.14 ± 2.25 mg/dL) and ETCOc (1.61 ± 0.45 vs 2.02 ± 1.35 ppm, p = 0.0002) were different between the groups. About 36.6% of infants with TB/TcB ≥75th percentile had ETCOc ≥ 2.0 ppm. In the subcohort of infants with serial TB/TcB measurements (n = 76), 44.7% and 55.3% had TB/TcB<75th and ≥75th percentile, respectively. TB/TcB (5.28 ± 1.97 vs 9.53 ± 2.78 mg/dL), ETCOc (1.72 ± 0.48 vs 2.38 ± 1.89 ppm, p = 0.05) and TB ROR (0.011 ± 0.440 vs 0.172 ± 0.471 mg/dL/h) were different between the groups.
The combined use of TB/TcB percentile risk assessments and ETCOc measurements can identify infants with haemolytic hyperbilirubinaemia. The addition of TB ROR can identify those infants with elimination disorders.
通过同时测量总血清/血浆胆红素（TB）或经皮胆红素（TcB）和呼气末呼吸一氧化碳（ETCOc），并校正环境 CO（ETCOc），以识别有发生溶血性高胆红素血症风险的新生儿，ETCOc 是胆红素生成和溶血的指标。
在五个新生儿病房中，在 20 至<60 小时龄的新生儿（n=283）中同时测量 TB/TcB（mg/dL）和 ETCOc（ppm）。使用 Bhutani 小时特异性列线图将 TB/TcB 值分配给 TB/TcB 百分位风险值。在有两次连续 TB/TcB 测量的婴儿中（n=76），计算 TB 上升率（ROR，mg/dL/h）。
对于整个队列（n=283），分别有 67.1%和 32.9%的婴儿 TB/TcB<75 百分位和≥75 百分位。TB/TcB（5.79±1.84 vs 9.14±2.25 mg/dL）和 ETCOc（1.61±0.45 vs 2.02±1.35 ppm，p=0.0002）在两组之间存在差异。约 36.6%的 TB/TcB≥75 百分位婴儿的 ETCOc≥2.0 ppm。在有连续 TB/TcB 测量的亚组中（n=76），分别有 44.7%和 55.3%的婴儿 TB/TcB<75 百分位和≥75 百分位。TB/TcB（5.28±1.97 vs 9.53±2.78 mg/dL）、ETCOc（1.72±0.48 vs 2.38±1.89 ppm，p=0.05）和 TB ROR（0.011±0.440 vs 0.172±0.471 mg/dL/h）在两组之间存在差异。
TB/TcB 百分位风险评估和 ETCOc 测量的联合使用可以识别有溶血性高胆红素血症风险的婴儿。TB ROR 的增加可以识别那些有胆红素消除障碍的婴儿。
