Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Queens University, Kingston, Ontario, Canada.
Department of Maternal, Newborn, Child, Adolescent Health and Aging, World Health Organization WHO.
J Glob Health. 2022 Dec 29;12:12007. doi: 10.7189/jogh.12.12007.
All term healthy neonates are screened for jaundice before hospital discharge as a standard clinical practice, but methods vary from clinical screening (visual inspection and/or risk factor assessment) to transcutaneous bilirubin (TcB) or total serum bilirubin (TSB) testing, depending on the setting.
This systematic review of randomized and non-randomized studies evaluated the effectiveness of universal TcB and universal TSB screening at discharge compared to clinical screening alone for term healthy neonates. The outcomes were neonatal mortality, readmission for jaundice, severe hyperbilirubinemia (>20 mg/dL), jaundice requiring exchange transfusion, and bilirubin-induced neurological dysfunction (BIND). We searched MEDLINE via Ovid, EBM reviews, Embase, CINAHL, clinical trials databases, and reference lists of retrieved articles. Two authors separately evaluated the risk of bias, extracted data, and synthesized effect estimates using relative risk (RR) for randomized and odds ratio (OR) for non-randomized studies.
For universal TcB at discharge, we included one randomized trial enrolling 1858 participants and four non-randomized studies enrolling 375 956 participants. No study reported neonatal mortality. The randomized trial suggested that universal TcB at discharge may decrease readmission for jaundice (risk ratio (RR) = 0.24, 95% confidence interval (CI) = 0.13 to 0.46; low certainty evidence) and severe hyperbilirubinemia (RR = 0.27, 95% CI = 0.08 to 0.97; low certainty evidence), but the effect on jaundice requiring exchange transfusion (RR = 0.20, 95% CI = 0.01 to 41.6) and BIND (RR = 0.33, 95% CI = 0.01 to 8.17) was uncertain. Meta-analysis of non-randomized studies suggested that TcB may decrease severe hyperbilirubinemia (odds ratio (OR) = 0.25, 95% = CI 0.12 to 0.52; low certainty evidence) and jaundice requiring exchange transfusion (OR = 0.28, 95% CI = 0.19 to 0.42; low certainty evidence), but the effect on readmission for jaundice was uncertain (OR = 1.01, 95% CI = 0.38 to 2.7; very low certainty evidence). For universal TSB, we included three studies from the United States enrolling 490 426 participants. The effect on severe hyperbilirubinemia (OR = 0.37, 95% CI = 0.15 to 0.88), jaundice requiring exchange transfusion (OR = 0.53, 95% CI = 0.13 to 2.25) and readmission for jaundice (OR = 1.01, 95% CI = 0.62 to 1.67) was uncertain.
Universal TcB at discharge may improve clinical outcomes for term healthy neonates. Evidence for universal TSB is uncertain.
PROSPERO 2020 CRD42020187279.
所有足月健康新生儿在出院前都会进行黄疸筛查，这是一项标准的临床实践，但方法因设置而异，包括临床筛查（视觉检查和/或危险因素评估）、经皮胆红素（TcB）或总血清胆红素（TSB）检测。
本系统评价纳入了随机和非随机研究，评估了与仅临床筛查相比，在出院时对足月健康新生儿进行普遍 TcB 和 TSB 筛查的效果。结局指标为新生儿死亡率、因黄疸而再次入院、严重高胆红素血症（>20mg/dL）、需要换血治疗的黄疸和胆红素诱导的神经功能障碍（BIND）。我们通过 Ovid 中的 MEDLINE、EBM 评价、Embase、CINAHL、临床试验数据库和检索文章的参考文献列表进行了检索。两名作者分别评估了偏倚风险、提取数据，并使用随机研究的相对风险（RR）和非随机研究的比值比（OR）综合效应估计值。
对于出院时的普遍 TcB，我们纳入了一项纳入 1858 名参与者的随机试验和四项纳入 375956 名参与者的非随机研究。没有研究报告新生儿死亡率。随机试验表明，出院时普遍进行 TcB 可能会降低因黄疸再次入院的风险（风险比（RR）=0.24，95%置信区间（CI）=0.13 至 0.46；低确定性证据）和严重高胆红素血症（RR=0.27，95%CI=0.08 至 0.97；低确定性证据），但对需要换血治疗的黄疸（RR=0.20，95%CI=0.01 至 41.6）和 BIND（RR=0.33，95%CI=0.01 至 8.17）的影响尚不确定。非随机研究的荟萃分析表明，TcB 可能会降低严重高胆红素血症（比值比（OR）=0.25，95%CI=0.12 至 0.52；低确定性证据）和需要换血治疗的黄疸（OR=0.28，95%CI=0.19 至 0.42；低确定性证据），但对因黄疸再次入院的影响尚不确定（OR=1.01，95%CI=0.38 至 2.7；极低确定性证据）。对于普遍 TSB，我们纳入了来自美国的三项研究，共纳入 490426 名参与者。严重高胆红素血症（OR=0.37，95%CI=0.15 至 0.88）、需要换血治疗的黄疸（OR=0.53，95%CI=0.13 至 2.25）和因黄疸再次入院（OR=1.01，95%CI=0.62 至 1.67）的效果尚不确定。
出院时普遍进行 TcB 可能会改善足月健康新生儿的临床结局。普遍进行 TSB 的证据尚不确定。
PROSPERO 2020 CRD42020187279。
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