Division of Perinatal Medicine, Policlinico Abano Terme, Abano Terme, Italy.
Department of Anesthesia, University of Toronto, Toronto, Canada.
J Matern Fetal Neonatal Med. 2021 Apr;34(7):1120-1126. doi: 10.1080/14767058.2019.1627318. Epub 2019 Jun 14.
To assess whether arterial umbilical cord bilirubin (aUCB) level at delivery predicts predischarge neonatal hyperbilirubinemia, facilitating a safe discharge from the hospital.
Prospective analysis of hospital biochemistry records identified near term and term infants with recorded aUCB and predischarge, at 36 h of life, capillary heal bilirubin (cHB), to identify those with a cutoff of bilirubin levels >9 mg/ml, >75th percentile on the nomogram of Bhutani et al.
Of 616 study neonates, median (IQR) aUCB and cHB levels were 1.5 mg % (IQR 0.7-2.2) and 7.7 mg % (IQR 6.6-8.9), respectively. The values resulted statistically correlated (Pearson correlation coefficient 0.26, < .0001) and an increment of 1 mg/dl in aUCB was associated with an increment (Regression coefficient, 95% confidence interval) of mean cHB 0.49 (0.33-0.65, < .0001). Among these, 143 (23.2%) neonates developed bilirubin levels >9 mg/ml at 36 h of life and multivariable analysis confirmed that cHB levels (OR 1.49, 95% CI 1.22-1.82; < .0001) and vaginal delivery (OR 2.34, 95% CI 1.33-4.36; = .005) were significantly associated with bilirubin levels >9 mg/ml.
These data suggest that aUCB should be added to the list of major risk factors for neonatal hyperbilirubinemia.
评估分娩时脐动脉胆红素（aUCB）水平是否可预测新生儿出院前高胆红素血症，从而安全出院。
对医院生化记录进行前瞻性分析，以确定记录有 aUCB 和出生后 36 小时内毛细血管胆红素（cHB）的近足月和足月婴儿，以识别胆红素水平>9mg/dl 的婴儿，Bhutani 等的列线图>75 百分位。
在 616 名研究新生儿中，中位数（IQR）aUCB 和 cHB 水平分别为 1.5mg%（IQR 0.7-2.2）和 7.7mg%（IQR 6.6-8.9）。这些值在统计学上呈正相关（Pearson 相关系数 0.26，<0.0001），aUCB 增加 1mg/dl 与 cHB 平均水平增加（回归系数，95%置信区间）相关 0.49（0.33-0.65，<0.0001）。其中，143 名（23.2%）新生儿在出生后 36 小时内胆红素水平>9mg/dl，多变量分析证实 cHB 水平（OR 1.49，95%CI 1.22-1.82；<0.0001）和阴道分娩（OR 2.34，95%CI 1.33-4.36；=0.005）与胆红素水平>9mg/dl 显著相关。
这些数据表明，aUCB 应添加到新生儿高胆红素血症的主要危险因素列表中。
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