Division of Neonatology, Department of Pediatrics, Children's Hospital of Michigan, Central Michigan University, Detroit, MI.
J Pediatr. 2023 Mar;254:91-95. doi: 10.1016/j.jpeds.2022.10.030. Epub 2022 Nov 3.
To evaluate the effect of intravenous (IV) ceftriaxone on free bilirubin concentrations in infants with unconjugated hyperbilirubinemia born at term.
A prospective study was performed with subjects serving as their own controls. Our inclusion criteria were infants born at term <7 days old with sepsis and receiving IV antibiotics for >3 days and resolving hyperbilirubinemia with total serum bilirubin levels between 6 and12 mg/dL by day 4 of life. Free bilirubin concentrations were measured by the peroxidase method using a UB analyzer and a Zone Fluidics device before (baseline) and 15 minutes after (follow-up) IV ceftriaxone administration on postnatal days 4 to 6. Paired measurements of free bilirubin were analyzed using a Student paired t-test or Wilcoxon signed-rank test.
In total, 27 infants were studied. The mean free bilirubin (μg/dL) at follow-up was not different from that at baseline when measured by the UB analyzer (P = .78). The mean free bilirubin was significantly lower at follow-up compared with baseline when measured by the Zone Fluidics device (P = .02). The ratio of a free bilirubin with and without ceftriaxone, an index of displacing effect, was 1.02 (95% CI 0.89-1.14) using the UB analyzer and 0.58 (95% CI 0.30-0.86) using the Zone Fluidics device.
Ceftriaxone is not associated with a bilirubin-displacing effect in infants with a mild unconjugated hyperbilirubinemia. Home therapy with once-daily intramuscular ceftriaxone may be an alternative option for management of sepsis in asymptomatic infants with a mild unconjugated hyperbilirubinemia born at term.
评估静脉注射头孢曲松对足月出生未结合高胆红素血症婴儿游离胆红素浓度的影响。
这是一项前瞻性研究，采用自身对照。纳入标准为：出生胎龄<7 天、患有败血症且接受静脉抗生素治疗>3 天、在出生后第 4 天总血清胆红素水平为 6-12mg/dL 时消退高胆红素血症的婴儿。游离胆红素浓度采用 UB 分析仪和 Zone Fluidics 设备的过氧化物酶法在出生后第 4-6 天测量，在静脉注射头孢曲松前（基线）和 15 分钟后（随访）进行。采用学生配对 t 检验或 Wilcoxon 符号秩检验对游离胆红素的配对测量值进行分析。
共 27 例婴儿纳入研究。采用 UB 分析仪测量时，随访时的游离胆红素（μg/dL）与基线时无差异（P=0.78）。采用 Zone Fluidics 设备测量时，随访时的游离胆红素显著低于基线时（P=0.02）。头孢曲松的游离胆红素与无游离胆红素的比值（游离胆红素置换效果指数）为 1.02（95%CI 0.89-1.14），采用 UB 分析仪，0.58（95%CI 0.30-0.86），采用 Zone Fluidics 设备。
头孢曲松与足月出生轻度未结合高胆红素血症婴儿的胆红素置换效果无关。对于无症状的足月出生轻度未结合高胆红素血症婴儿，头孢曲松每日一次肌内注射家庭治疗可能是管理败血症的替代选择。
