胎龄>35周健康新生儿脐带血胆红素预测光疗需求的诊断准确性：一项系统评价和荟萃分析
Diagnostic Accuracy of Cord Bilirubin to Predict the Need for Phototherapy in Healthy Neonates >35-Week Gestational Age: A Systematic Review and Meta-Analysis.
作者信息
Anne Rajendra Prasad, Rahiman Emine A, Dudeja Sankalp, Kumar Ashutosh
机构信息
All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, India.
Sita Ram Bhartia Institute of Science and Research, New Delhi, India.
出版信息
J Clin Exp Hepatol. 2023 Jul-Aug;13(4):666-681. doi: 10.1016/j.jceh.2022.11.011. Epub 2022 Nov 26.
OBJECTIVE
Early discharge puts neonates at risk of delayed detection of jaundice and resulting neurological injury. In these neonates, we can use cord bilirubin to make predictions. In this meta-analysis, we assessed the diagnostic accuracy of cord bilirubin in predicting the need for phototherapy (AAP-2004 or NICE-2010 charts).
METHODS
We searched the databases of PubMed, Embase, Cochrane Library, Google Scholar, and Index Medicus for Southeast Asian Region. We included all observational studies that assessed the diagnostic accuracy of cord bilirubin. A bivariate model was used to pool the data in prespecified range of cord bilirubin levels (<1.5 mg/dl, 1.5-2.0 mg/dl, 2.0-2.5 mg/dl, 2.5-3.0 mg/dl, and >3.0 mg/dl). Data were pooled separately for studies including all neonates (no risk stratification), high-risk neonates (Rh and/or ABO incompatibility only), and low-risk neonates (excluded Rh and ABO incompatibility).
RESULTS
Of the 1990 unique records, we studied 153 full texts and included 54 studies in the meta-analysis. For all the three groups of studies, the highest diagnostic odds ratio was noted for a cord bilirubin cut-off of 2.5-3.0 mg/dl (all neonates: 22.5, 95% CI: 21.1, 22.9; high-risk neonates: 75.5, 95% CI: 63, 85.7; low-risk neonates: 91.9; 95% CI: 64, 134.14). Using the same cut-off, the studies including all neonates without risk stratification had a pooled sensitivity of 0.31 (95% CI: 0.18, 0.47) and a pooled specificity of 0.98 (0.96, 0.99) in predicting the need for phototherapy. In studies on high-risk neonates, the pooled sensitivity was 0.8 (0.39, 0.96) and pooled specificity was 0.95 (0.78, 0.99). In studies on low-risk neonates, the pooled sensitivity was 0.74 (0.39, 0.93) and pooled specificity of 0.97 (0.91, 0.99). We noted significant heterogeneity and a high risk of bias in the index test's conduct.
CONCLUSION
A cord bilirubin cut-off of 2.5-3 mg/dl has good diagnostic accuracy in predicting the need for phototherapy in neonates.
REGISTRATION NUMBER
CRD42020196216.
目的
早期出院使新生儿有黄疸延迟检测及由此导致神经损伤的风险。对于这些新生儿，我们可以使用脐血胆红素进行预测。在这项荟萃分析中，我们评估了脐血胆红素在预测光疗需求（美国儿科学会2004年或英国国家卫生与临床优化研究所2010年图表）方面的诊断准确性。
方法
我们检索了PubMed、Embase、Cochrane图书馆、谷歌学术和东南亚地区医学索引数据库。我们纳入了所有评估脐血胆红素诊断准确性的观察性研究。采用双变量模型在预先设定的脐血胆红素水平范围（<1.5mg/dl、1.5 - 2.0mg/dl、2.0 - 2.5mg/dl、2.5 - 3.0mg/dl和>3.0mg/dl）内汇总数据。分别针对包括所有新生儿（无风险分层）、高危新生儿（仅Rh和/或ABO血型不合）和低危新生儿（排除Rh和ABO血型不合）的研究汇总数据。
结果
在1990条独特记录中，我们研究了153篇全文，并将54项研究纳入荟萃分析。对于所有三组研究，脐血胆红素临界值为2.5 - 3.0mg/dl时诊断比值比最高（所有新生儿：22.5，95%可信区间：21.1，22.9；高危新生儿：75.5，95%可信区间：63，85.7；低危新生儿：91.9；95%可信区间：64，134.14）。使用相同的临界值，在预测光疗需求方面，未进行风险分层的所有新生儿研究汇总敏感度为0.31（95%可信区间：0.18，0.47），汇总特异度为0.98（0.96，0.99）。在高危新生儿研究中，汇总敏感度为0.8（0.39，0.96），汇总特异度为0.95（0.78，0.99）。在低危新生儿研究中，汇总敏感度为0.74（0.39，0.93），汇总特异度为0.97（0.91，0.99）。我们注意到索引测试实施过程中存在显著异质性和高偏倚风险。
结论
脐血胆红素临界值为2.5 - 3mg/dl在预测新生儿光疗需求方面具有良好的诊断准确性。
注册号
CRD42020196216。
Zotero 插件