Phototherapy to Prevent Severe Neonatal Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation
Phototherapy to Prevent Severe Neonatal Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation
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DOI：
10.1542/peds.2011-1494
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发表时间：
2011-10-01
期刊：
影响因子：
8
通讯作者：
Bhutani, Vinod K.
中科院分区：
文献类型：
--
作者：
Bhutani, Vinod K.
目的：标准化光疗的使用符合美国儿科学会临床实践指南的新生儿高胆红素血症的管理35周或以上的gestation.METHODS：相关文献进行了综述。光疗设备目前在美国上市，将荧光，卤素，光纤，或蓝色发光二极管光源进行了评估，在laborator.RESULTS：光疗单位的疗效差异很大，因为在光源和配置的差异。器械的以下特征有助于其有效性：（1）在与体内血浆胆红素吸收光谱（类似于460-490 nm）重叠的蓝色至绿色范围内发射光;（2）辐照度至少为30 mu W.cm（-2）.nm（-1）（用在适当波长范围内校准的适当辐照度计确认）;（3）最大体表的照明;和（4）在暴露的前4 - 6小时内总胆红素浓度降低的证明。建议（分级定义见附录）：光疗设备的强度和光谱输出在预测治疗高胆红素血症的潜在有效性方面是有用的（B组建议）。应在使用前评价临床有效性并在使用过程中进行监测（B组建议）。应避免阻挡光源或减少暴露的身体表面（B组建议）。辐照度计的标准化、设备设计的改进以及光疗装置光强的下限和上限值得进一步研究。通常，比较器械的体内性能是不切实际的，需要探索替代手术。儿科2011;128：e1046-e1052
OBJECTIVE: To standardize the use of phototherapy consistent with the American Academy of Pediatrics clinical practice guideline for the management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation.METHODS: Relevant literature was reviewed. Phototherapy devices currently marketed in the United States that incorporate fluorescent, halogen, fiber-optic, or blue light-emitting diode light sources were assessed in the laboratory.RESULTS: The efficacy of phototherapy units varies widely because of differences in light source and configuration. The following characteristics of a device contribute to its effectiveness: (1) emission of light in the blue-to-green range that overlaps the in vivo plasma bilirubin absorption spectrum (similar to 460-490 nm); (2) irradiance of at least 30 mu W.cm(-2).nm(-1) (confirmed with an appropriate irradiance meter calibrated over the appropriate wavelength range); (3) illumination of maximal body surface; and (4) demonstration of a decrease in total bilirubin concentrations during the first 4 to 6 hours of exposure.RECOMMENDATIONS (SEE APPENDIX FOR GRADING DEFINITION): The intensity and spectral output of phototherapy devices is useful in predicting potential effectiveness in treating hyperbilirubinemia (group B recommendation). Clinical effectiveness should be evaluated before and monitored during use (group B recommendation). Blocking the light source or reducing exposed body surface should be avoided (group B recommendation). Standardization of irradiance meters, improvements in device design, and lower-upper limits of light intensity for phototherapy units merit further study. Comparing the in vivo performance of devices is not practical, in general, and alternative procedures need to be explored. Pediatrics 2011;128:e1046-e1052