Watchko J F, Claassen D
Department of Pediatrics, Magee-Womens Hospital, University of Pittsburgh School of Medicine, PA 15213.
Pediatrics. 1994 Jun;93(6 Pt 1):996-9.
This study was undertaken to determine the current prevalence of kernicterus in premature neonates and to relate the occurrence of kernicterus to 1) the categorization of the infant as "at risk" by National Institute of Child Health and Human Development (NICHD) Phototherapy Study exchange transfusion criteria, and 2) the clinical management of the infant's hyperbilirubinemia.
Retrospective review of postmortem and clinical records.
Magee-Womens Hospital, a University of Pittsburgh Medical Center affiliated hospital with approximately 10,000 deliveries per year and a Level III Neonatal Intensive Care Unit with about 1400 admissions annually.
All neonates autopsied between January 1, 1984 and June 30, 1993 who were < 34 weeks gestation and who lived at least 48 hours; a total of 81 infants.
Three infants had kernicterus resulting in a prevalence rate of 4%. These cases included: 1) a 33-week newborn with nonimmune hydrops and a peak bilirubin of 26 mg/dl; 2) a 25-week newborn with asphyxia, hyaline membrane disease, grade IV intraventricular hemorrhage, necrotizing enterocolitis, meconium peritonitis, sepsis, prolonged acidosis, and a peak bilirubin of 11.3 mg/dl; and 3) a 24-week newborn with asphyxia, hyaline membrane disease, grade III intraventricular hemorrhage, and a peak serum bilirubin of 18.5 mg/dl. Of the remaining 78 infants who did not have kernicterus, peak bilirubin ranged from 3.6 to 22.5 mg/dl and 56% had bilirubin levels greater than that suggested as a criterion for exchange transfusion by NICHD Phototherapy Study guidelines; yet all but three were managed with phototherapy alone.
We conclude that kernicterus is currently an uncommon event in preterm infants, even when bilirubin levels are allowed to rise above those previously thought to place the premature infant at risk.
本研究旨在确定目前早产儿核黄疸的患病率，并将核黄疸的发生情况与以下因素相关联：1）根据美国国立儿童健康与人类发展研究所（NICHD）光疗研究换血标准将婴儿分类为“高危”；2）婴儿高胆红素血症的临床管理。
对尸检和临床记录进行回顾性研究。
梅杰妇女医院，隶属于匹兹堡大学医学中心，每年约有10000例分娩，三级新生儿重症监护病房每年约有1400例入院。
1984年1月1日至1993年6月30日期间接受尸检的所有孕周小于34周且存活至少48小时的新生儿；共81例婴儿。
3例婴儿患有核黄疸，患病率为4%。这些病例包括：1）一名33周的新生儿，患有非免疫性水肿，胆红素峰值为26mg/dl；2）一名25周的新生儿，患有窒息、透明膜病、IV级脑室内出血、坏死性小肠结肠炎、胎粪性腹膜炎、败血症、长期酸中毒，胆红素峰值为11.3mg/dl；3）一名24周的新生儿，患有窒息、透明膜病、III级脑室内出血，血清胆红素峰值为18.5mg/dl。其余78例未患核黄疸的婴儿，胆红素峰值在3.6至22.5mg/dl之间，56%的婴儿胆红素水平高于NICHD光疗研究指南建议的换血标准；但除3例以外，所有婴儿仅接受光疗。
我们得出结论，目前核黄疸在早产儿中是一种罕见事件，即使胆红素水平升高至高于先前认为会使早产儿处于危险的水平。
