葡萄糖-6-磷酸脱氢酶缺乏症婴儿光照疗法需求的危险因素预测：一项大型回顾性队列研究。

Risk Factors Predicting the Need for Phototherapy in Glucose 6 Phosphate Dehydrogenase-Deficient Infants in a Large Retrospective Cohort Study.

机构信息

Department of Neonatology, KK Women's and Children's Hospital, Singapore, Singapore.

Yong Loo Lin School of Medicine, NUS, Singapore, Singapore.

出版信息

Neonatology. 2022;119(4):494-500. doi: 10.1159/000524966. Epub 2022 Jun 14.

DOI:10.1159/000524966

PMID:35700699

Abstract

INTRODUCTION

Glucose 6-phosphate dehydrogenase (G6PD) deficiency increases the risk of severe neonatal hyperbilirubinemia. This study evaluates the risk factors predicting the need for phototherapy in G6PD-deficient neonates after 72 h of age and assesses the safety of early discharge.

METHODS

A retrospective cohort study of 681 full-term G6PD-deficient infants with a birth weight ≥2,500 g over 4 years was conducted. We compared the baseline characteristics, bilirubin level on day 4 (after 72 h of life), day of peak bilirubin, G6PD levels, and concomitant ABO incompatibility between the group that required phototherapy (Group A) and those who did not (Group B).

RESULTS

396 infants (58%), predominantly males, required phototherapy in the first week of life. The infants who required phototherapy had a lower median gestational age (38.3 vs. 38.7 weeks, p < 0.01) and had lower G6PD levels (2.3 ± 2.5 vs. 3 ± 3.4 IU, p < 0.05) compared to the controls. The mean day-four total serum bilirubin (TSB) levels were higher (213 ± 32 vs. 151 ± 37 µmol/L, p < 0.01), with bilirubin level peaking earlier (3 vs. 4 days of life, p < 0.01) in group A. Regression analysis identified TSB levels on day 4, Chinese race, lower gestation, and concomitant ABO incompatibility as the significant predictors for the need for phototherapy in the study population. In particular, coexisting ABO blood group incompatibility increased the risk of jaundice requiring phototherapy (OR 4.27, 95% CI: 1.98-121, p < 0.01). Day four TSB values above 180 µmol/L predicted the need for phototherapy with 86% sensitivity and 80% specificity. The findings were similar across both male and female infants with G6PD deficiency.

CONCLUSION

G6PD-deficient infants with day four TSB levels of >180 µmol/L (10.5 mg/dL) and associated ABO blood group incompatibility have a higher risk of requiring phototherapy in the first week of life and should be closely monitored.

摘要

引言

葡萄糖-6-磷酸脱氢酶（G6PD）缺乏症会增加新生儿重度高胆红素血症的风险。本研究评估了 G6PD 缺乏症新生儿在出生后 72 小时后需要光疗的预测因素，并评估了提前出院的安全性。

方法

对 4 年来 681 例出生体重≥2500 克的足月 G6PD 缺乏症婴儿进行回顾性队列研究。我们比较了需要光疗组（A 组）和无需光疗组（B 组）的基线特征、第 4 天（出生后 72 小时）胆红素水平、胆红素峰值日、G6PD 水平和同时存在的 ABO 不合。

结果

396 名（58%）婴儿，主要为男性，在生命的第一周需要光疗。需要光疗的婴儿胎龄中位数较低（38.3 周比 38.7 周，p <0.01），G6PD 水平也较低（2.3 ± 2.5 vs. 3 ± 3.4 IU，p <0.05）。与对照组相比，第 4 天总血清胆红素（TSB）水平较高（213 ± 32 vs. 151 ± 37 μmol/L，p <0.01），胆红素峰值较早（3 天比 4 天，p <0.01）。回归分析确定第 4 天 TSB 水平、中国种族、较低的胎龄和同时存在的 ABO 不合是研究人群中需要光疗的显著预测因素。特别是，同时存在 ABO 血型不合会增加需要光疗的黄疸风险（OR 4.27，95%CI：1.98-121，p <0.01）。第 4 天 TSB 值超过 180 μmol/L 预测需要光疗的灵敏度为 86%，特异性为 80%。在 G6PD 缺乏的男性和女性婴儿中，结果均相似。