Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands (Drs Ree and Haas); Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands (Dr Ree, Ms Oever, and Dr Lopriore).
Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands (Dr Ree, Ms Oever, and Dr Lopriore).
Am J Obstet Gynecol MFM. 2021 May;3(3):100332. doi: 10.1016/j.ajogmf.2021.100332. Epub 2021 Feb 18.
Fetal bilirubin is routinely measured at our center when taking a pretransfusion blood sample at intrauterine transfusions in hemolytic disease of the fetus and newborn. However, the clinical value of fetal bilirubin assessment is not well known, and the information is rarely used. We speculated that there could be a role for this measurement in predicting the need for neonatal exchange transfusion.
This study aimed to evaluate the predictive value of fetal bilirubin for exchange transfusions in severe hemolytic disease of the fetus and newborn.
A total of 186 infants with Rh alloantibody-mediated hemolytic disease of the fetus and newborn treated with one or more intrauterine transfusions at the Leiden University Medical Center between January 2006 and June 2020 were included in this observational study. Antenatal and postnatal factors were compared between infants with and without exchange transfusion treatments. The primary outcome was the fetal bilirubin levels before the last intrauterine transfusion in relation to the need for exchange transfusion.
In a multivariate logistic regression analysis, the fetal bilirubin level before the last intrauterine transfusions (odds ratio, 1.32; 95% confidence interval, 1.09-1.61 per 1 mg/dL) and the total number of intrauterine transfusions (odds ratio, 0.63; 95% confidence interval, 0.44-0.91 per intrauterine transfusion) were independently associated with the need for exchange transfusion. The area under the curve was determined at 0.71. A Youden index was calculated at 0.43. The corresponding fetal bilirubin level was 5 mg/dL and had a sensitivity of 79% and a specificity of 64%.
A high fetal bilirubin level before the last intrauterine transfusion was associated with a high likelihood of neonatal exchange transfusion.
在我们中心，当对胎儿和新生儿溶血病进行宫内输血时，会常规测量胎儿胆红素。然而，胎儿胆红素评估的临床价值尚不清楚，并且很少使用该信息。我们推测，该测量可能在预测新生儿换血的需求方面发挥作用。
本研究旨在评估胎儿胆红素对严重胎儿和新生儿溶血病换血的预测价值。
本观察性研究纳入了 2006 年 1 月至 2020 年 6 月在莱顿大学医学中心接受一次或多次宫内输血治疗的 Rh 同种异体抗体介导的胎儿和新生儿溶血病的 186 例婴儿。比较了有和没有换血治疗的婴儿的产前和产后因素。主要结局是最后一次宫内输血前的胎儿胆红素水平与换血治疗的需求。
在多变量逻辑回归分析中，最后一次宫内输血前的胎儿胆红素水平（优势比，1.32；95%置信区间，每增加 1mg/dL 为 1.09-1.61）和宫内输血总数（优势比，0.63；95%置信区间，每增加一次宫内输血为 0.44-0.91）与换血治疗的需求独立相关。曲线下面积为 0.71。计算了一个 Youden 指数为 0.43。对应的胎儿胆红素水平为 5mg/dL，灵敏度为 79%，特异性为 64%。
最后一次宫内输血前的高胎儿胆红素水平与新生儿换血的高可能性相关。
