Meberg A, Johansen K B
Department of Paediatrics, Vestfold County Central Hospital, Tønsberg, Norway.
Acta Paediatr. 1998 Dec;87(12):1269-74. doi: 10.1080/080352598750030960.
In a population-based study including 2463 infants, serum bilirubin measurements were added to the neonatal screening programme for phenylketonuria and congenital hypothyreosis. This screening programme detected 11/17 (65%) of infants with serum bilirubin levels >350 micromol 1(-1), of whom 7 (3 per 1000) were readmitted from home (6 treated with phototherapy). A total of 139 infants (5.6%) received phototherapy. Maternal blood type O occurred significantly more often in term infants treated (30/54; 55.6%) compared with preterm infants treated (32/85; 37.6%) and with blood type O occurrence in the total population of mothers (906/2426; 37.3%) (p < 0.05). The blood type constellations mother O/infant A or B showed a sensitivity of 64%, specificity 65%, positive predictive value 12% and a negative predictive value of 96% for the requirement of phototherapy for the whole material. Exchange transfusion was not required in any of the infants. No infant developed bilirubin encephalopathy (kemicterus). Adding bilirubin to a neonatal screening programme detects some cases with unexpectedly high bilirubin levels in need of intervention. Routine ABO blood typing of pregnant women, ABO cord blood typing and Coombs' test in infants of mothers with blood type O cannot be recommended because of low positive predictive value for the requirement of intervention (phototherapy) by these tests.
在一项纳入2463名婴儿的基于人群的研究中，血清胆红素检测被纳入苯丙酮尿症和先天性甲状腺功能减退症的新生儿筛查项目。该筛查项目检测出17名血清胆红素水平>350微摩尔/升的婴儿中的11名（65%），其中7名（每1000名中有3名）从家中再次入院（6名接受了光疗）。共有139名婴儿（5.6%）接受了光疗。与接受治疗的早产儿（32/85；37.6%）以及母亲总体人群中O型血的发生率（906/2426；37.3%）相比，接受治疗的足月儿中母亲O型血的发生率显著更高（30/54；55.6%）（p<0.05）。母亲O型血/婴儿A型或B型的血型组合对整个研究对象光疗需求的敏感性为64%，特异性为65%，阳性预测值为12%，阴性预测值为96%。所有婴儿均未需要换血治疗。没有婴儿发生胆红素脑病（核黄疸）。在新生儿筛查项目中增加胆红素检测能发现一些胆红素水平意外升高且需要干预的病例。由于这些检测对干预（光疗）需求的阳性预测值较低，因此不建议对O型血母亲的孕妇进行常规ABO血型分型、对婴儿进行ABO脐血血型分型和库姆斯试验。
