Lee K, Gartner L M, Eidelman A I, Ezhuthachan S
Clin Perinatol. 1977 Sep;4(2):305-20.
In very low birth weight infants, the occurrence of bilirubin-related brain damage has been repeatedly observed at low serum bilirubin concentrations in close association with altered pathophysiologic status (hypoxia, acidosis, hypothermia, and so on). This increased susceptibility is accompanied by increased severity and duration of unconjugated hyperbilirubinemia as compared with more mature infants. Clinical manifestations of kernicterus in very low birth weight infants are almost always nonspecific. No single biochemical or physiologic measurement is sufficient to predict the risk for development of the bilirubin-related brain damage in this group. Prevention of bilirubin-related brain damage in very low birth weight infants requires not only the maintenance of physiologic and biochemical milieu within normal limits, but also specific therapy to alleviate unconjugated hyperbilirubinemia. Although exchange transfusion has been the mainstay of therapy for unconjugated hyperbilirubinemia, the increased morbidity and mortality associated with exchange transfusion in these immature infants and the need to maintain very low serum bilirubin concentrations suggest that prophylactic phototherapy may be more beneficial for this group.
在极低出生体重儿中，在血清胆红素浓度较低时，与病理生理状态改变（缺氧、酸中毒、体温过低等）密切相关的情况下，反复观察到胆红素相关脑损伤的发生。与更成熟的婴儿相比，这种易感性增加伴随着未结合型高胆红素血症的严重程度和持续时间增加。极低出生体重儿核黄疸的临床表现几乎总是非特异性的。没有单一的生化或生理测量足以预测该组中胆红素相关脑损伤的发生风险。预防极低出生体重儿胆红素相关脑损伤不仅需要将生理和生化环境维持在正常范围内，还需要采取特定疗法来减轻未结合型高胆红素血症。尽管换血疗法一直是治疗未结合型高胆红素血症的主要手段，但这些不成熟婴儿换血疗法相关的发病率和死亡率增加，以及维持极低血清胆红素浓度的必要性表明，预防性光疗可能对该组更有益。
