Dani Carlo, Becciani Sabrina, Pratesi Simone
Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy; Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy.
Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy.
Early Hum Dev. 2019 Apr;131:41-44. doi: 10.1016/j.earlhumdev.2019.02.007. Epub 2019 Mar 2.
There is no standardized method for total serum bilirubin (TSB) monitoring during phototherapy for neonatal hyperbilirubinemia and national guidelines give heterogeneous indications.
To assess the hypothesis that TSB values do not exceed exsanguino-transfusion (EXT) threshold during phototherapy and that it is possible to decrease its monitoring frequency in jaundiced infants.
We carried out a prospective observational study in which changes in TSB during phototherapy for non-haemolytic hyperbilirubinemia were recorded in a cohort of late preterm and term infants. TSB values after 6, 12, 18, and 24 h of phototherapy were compared to the EXT threshold matched to infants' gestational and postnatal age according to the specific nomogram of the Italian Society of Neonatology guidelines.
We studied 105 infants who started phototherapy at a mean age of 89 ± 37 h when mean TSB was 17.1 ± 2.5 mg/dL. We found that TSB decreased during phototherapy and the difference between mean TSB and EXT threshold progressively increased during phototherapy; TSB exceeded EXT threshold in none of our patients (0%).
Our study demonstrates that differences between mean TSB and EXT threshold increased during phototherapy in late preterm and term infants with non-haemolytic hyperbilirubinemia; in none of our patients TSB exceeded EXT threshold. Our findings support the possibility of safely decreasing TSB monitoring during phototherapy, thus limiting noxious painful stimuli in neonates.
在新生儿高胆红素血症光疗期间,尚无标准化的总血清胆红素(TSB)监测方法,国家指南给出的指示也不一致。
评估以下假设,即在光疗期间TSB值不会超过换血阈值,并且有可能降低黄疸婴儿的监测频率。
我们进行了一项前瞻性观察研究,记录了一组晚期早产儿和足月儿在非溶血性高胆红素血症光疗期间TSB的变化。根据意大利新生儿学会指南的特定列线图,将光疗6、12、18和24小时后的TSB值与匹配婴儿胎龄和出生后年龄的换血阈值进行比较。
我们研究了105例婴儿,他们在平均年龄89±37小时开始光疗,此时平均TSB为17.1±2.5mg/dL。我们发现光疗期间TSB下降,并且光疗期间平均TSB与换血阈值之间的差异逐渐增加;我们的患者中没有一例TSB超过换血阈值(0%)。
我们的研究表明,晚期早产儿和足月儿非溶血性高胆红素血症在光疗期间平均TSB与换血阈值之间的差异增加;我们的患者中没有一例TSB超过换血阈值。我们的研究结果支持在光疗期间安全降低TSB监测频率的可能性,从而限制新生儿的有害疼痛刺激。