在泰缅边境资源匮乏地区，对生命第一周内胆红素浓度进行非侵入性检测。

Non-invasive detection of bilirubin concentrations during the first week of life in a low-resource setting along the Thailand-Myanmar border.

机构信息

Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand

Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.

出版信息

BMJ Paediatr Open. 2024 Sep 28;8(1):e002754. doi: 10.1136/bmjpo-2024-002754.

DOI:10.1136/bmjpo-2024-002754

PMID:39343446

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11440201/

Abstract

BACKGROUND

Neonatal hyperbilirubinaemia (NH) is a common problem worldwide and is a cause of morbidity and mortality especially in low-resource settings.

METHODS

A study was carried out at Shoklo Malaria Research Unit (SMRU) clinics along the Thailand-Myanmar border to evaluate a non-invasive test for diagnosis of NH in a low-resource setting. Performance of a transcutaneous bilirubinometer Dräger Jaundice Meter JM-105 was assessed against routine capillary serum bilirubin testing (with BR-501 microbilirubinometer) before phototherapy during neonatal care in the first week of life. Results were analysed by direct agreement and by various bilirubin thresholds used in clinical practice. Total serum bilirubin was also measured in cord blood at birth and tested for prediction of hyperbilirubinaemia requiring phototherapy in the first week of life.

RESULTS

Between April 2020 and May 2023, 742 neonates born at SMRU facilities were included in the study. A total of 695 neonates provided one to nine capillary blood samples for analysis of serum bilirubin (total 1244 tests) during the first week of life. Performance of transcutaneous bilirubinometer was assessed in 307 neonates who provided 687 paired transcutaneous capillary blood tests. Bilirubin levels were also measured in 738 cord blood samples. Adjusted values of transcutaneous bilirubinometer showed excellent agreement with capillary serum bilirubin concentration (intraclass correlation coefficient=0.923) and high sensitivity (>98%) at all clinical thresholds analysed across 3 years of sampling and multiple users. Concentrations of bilirubin detected in cord blood were not useful in identifying neonates at risk of hyperbilirubinaemia requiring treatment.

CONCLUSIONS

The transcutaneous bilirubinometer is a reliable tool to screen neonates and identify those needing confirmatory blood testing. Bilirubin concentrations in cord blood are not predictive of hyperbilirubinaemia in neonates.

摘要

背景

新生儿高胆红素血症（NH）是一个全球性的常见问题，特别是在资源匮乏的环境中，它是发病率和死亡率的一个原因。

方法

在泰国-缅甸边境的肖克隆疟疾研究单位（SMRU）诊所进行了一项研究，以评估一种非侵入性测试在资源匮乏的环境中诊断 NH 的性能。在新生儿护理的第一周内，在光疗前，使用经皮胆红素计 Dräger Jaundice Meter JM-105 对常规毛细血管血清胆红素检测（使用 BR-501 微量胆红素计）进行了评估。结果通过直接一致性和临床实践中使用的各种胆红素阈值进行了分析。在出生时还测量了脐带血中的总血清胆红素，并对其进行了检测，以预测在第一周内需要光疗的高胆红素血症。

结果

在 2020 年 4 月至 2023 年 5 月期间，共有 742 名在 SMRU 设施出生的新生儿纳入了研究。共有 695 名新生儿在第一周内提供了一到九次毛细血管血样用于分析血清胆红素（总共 1244 次检测）。在 307 名提供了 687 次经皮毛细血管血样检测的新生儿中评估了经皮胆红素计的性能。在 738 份脐带血样本中也测量了胆红素水平。调整后的经皮胆红素计值与毛细血管血清胆红素浓度具有极好的一致性（组内相关系数=0.923），并且在 3 年的采样和多个用户分析中，在所有分析的临床阈值上均具有高灵敏度（>98%）。在脐带血中检测到的胆红素浓度对识别需要治疗的高胆红素血症风险的新生儿没有用处。