接受光疗的极低出生体重儿经皮胆红素测定：一项前瞻性观察研究。

Transcutaneous bilirubin estimation in extremely low birth weight infants receiving phototherapy: a prospective observational study.

作者信息

Bhargava Vidit, Tawfik Daniel, Niebuhr Bruce, Jain Sunil K

机构信息

Department of Pediatrics, Division of Pediatric Critical Care, Lucile Salter Packard Children's Hospital, 770 Welch Road, Suite 435, Palo Alto, CA, 94304, USA.

Department of Pediatrics, University of Texas Medical Branch, Galveston, TX, USA.

出版信息

BMC Pediatr. 2018 Jul 10;18(1):227. doi: 10.1186/s12887-018-1207-7.

DOI:10.1186/s12887-018-1207-7

PMID:29991353

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6040067/

Abstract

BACKGROUND

Measurement of transcutaneous bilirubin (TcB) is a quick, reliable and painless method to guide management of hyperbilirubinemia. Studies in term and late preterm infants have found that TcB measurements from covered areas (TcB-C) during phototherapy (PHT) co-relate well with serum bilirubin levels. Limited data exists in extremely low birth weight (ELBW) infants.

METHODS

In this prospective observational study, an opaque patch was placed on the back of an ELBW infant prior to initiation of PHT. TcB-C and TcB-E (TcB from exposed area) levels were measured at birth and at 24-h intervals for 5 days. Total serum bilirubin (TSB) levels were also measured within 30 min of obtaining TcB levels. A Wilcoxon signed rank test was used for data analysis. A mixed effect model was used to adjust for repeated measurements over time. The p value < 0.05 was considered significant.

RESULTS

A total of 19 infants were enrolled in the study, with a mean gestational age of 26 ± 2 weeks and mean weight 827 ± 127 g. The difference between TcB-C and TSB was 2.68 ± 2.41 mg/dl (mean ± SD, p < 0.001). In contrast, the difference between TcB-E and TSB was - 0.51 ± 1.74 mg/dl (p = 0.02). TcB-C consistently overestimates TSB, while TcB-E consistently underestimates TSB.

CONCLUSIONS

During PHT exposure, TcB-C does not correlate with TSB values in ELBW infants. TcB-C levels cannot be used as a surrogate for TSB measurement in ELBW infants.

摘要

背景

经皮胆红素（TcB）测量是指导高胆红素血症管理的一种快速、可靠且无痛的方法。对足月儿和晚期早产儿的研究发现，光疗（PHT）期间覆盖区域的TcB测量值（TcB-C）与血清胆红素水平密切相关。极低出生体重（ELBW）婴儿的数据有限。

方法

在这项前瞻性观察研究中，在开始PHT之前，在一名ELBW婴儿的背部放置一个不透明贴片。在出生时以及之后5天内每隔24小时测量一次TcB-C和TcB-E（暴露区域的TcB）水平。在获得TcB水平后30分钟内也测量总血清胆红素（TSB）水平。采用Wilcoxon符号秩检验进行数据分析。使用混合效应模型对随时间的重复测量进行调整。p值<0.05被认为具有统计学意义。

结果

共有19名婴儿纳入研究，平均胎龄为26±2周，平均体重为827±127克。TcB-C与TSB之间的差异为2.68±2.41mg/dl（平均值±标准差，p<0.001）。相比之下，TcB-E与TSB之间的差异为-0.51±1.74mg/dl（p=0.02）。TcB-C始终高估TSB，而TcB-E始终低估TSB。