Cairo Sarah B, Osak Alex H, Berkelhamer Sara K, McLaughlin Cara, Rothstein David H
Department of Pediatric Surgery, John R. Oishei Children's Hospital, 1001 Main Street, Buffalo, NY, 14203, USA.
Department of Pediatrics, John R. Oishei Children's Hospital, Buffalo, USA.
Pediatr Surg Int. 2019 Mar;35(3):293-301. doi: 10.1007/s00383-018-4415-1. Epub 2018 Nov 10.
Patients with gastroschisis and prolonged total (or partial) parenteral nutrition (PN) commonly develop direct hyperbilirubinemia (DH).
To quantify the prevalence and severity of DH in newborns with gastroschisis and characterize the diagnostic work-up for DH in this patient population.
DESIGN/METHODS: Retrospective chart review of patients born with gastroschisis between 2005 and 2015 for the first 6 months of life.
29 patients were identified with gastroschisis. Mean gestational age and birthweight were 36.4 (± 1.8) weeks and 2.5 (± 0.6) kg. 41% were treated with primary reduction versus staged closure. Peak total and direct bilirubin (DB) levels were 10.17 ± 6.21 mg/dL and 5.58 ± 3.94 mg/dL, respectively. 23 patients (79.3%) were diagnosed with DH and 78.2% underwent additional work-up for hyperbilirubinemia consisting of imaging and laboratory studies, none of which revealed a cause for DH other than the presumed PN-associated cholestasis. In all patients, DB began to decline within 1-10 days of initiation of enteral feeds.
CONCLUSION(S): DH is common in patients with gastroschisis and is unlikely to be associated with pathology aside from PN. Additional work-up may lead to unnecessary resource utilization.
Case series with no comparison group, Level IV.
腹裂患儿及长期接受全（或部分）肠外营养（PN）的患儿常发生直接胆红素血症（DH）。
量化腹裂新生儿DH的患病率和严重程度，并描述该患者群体中DH的诊断检查。
设计/方法：对2005年至2015年出生的腹裂患儿出生后头6个月的病历进行回顾性分析。
共确定29例腹裂患儿。平均胎龄和出生体重分别为36.4（±1.8）周和2.5（±0.6）kg。41%的患儿接受了一期修复术，而非分期关闭术。总胆红素和直接胆红素（DB）的峰值水平分别为10.17±6.21mg/dL和5.58±3.94mg/dL。23例（79.3%）患儿被诊断为DH，78.2%的患儿接受了针对高胆红素血症的进一步检查，包括影像学和实验室检查，除了推测与PN相关的胆汁淤积外，这些检查均未发现DH的病因。所有患儿在开始肠内喂养后1 - 10天内DB开始下降。
DH在腹裂患儿中很常见，除PN外不太可能与其他病理情况相关。进一步检查可能导致不必要的资源利用。
无对照组的病例系列，IV级。
