Neonatal cholestasis: opportunities to increase early detection.
Neonatal cholestasis: opportunities to increase early detection.
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DOI：
10.1016/j.acap.2012.03.021
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发表时间：
2012-07
影响因子：
3.1
通讯作者：
Garbutt, Jane
中科院分区：
文献类型：
--
作者：
Palermo, Joseph J.;Joerger, Shannon;Turmelle, Yumirle;Putnam, Peter;Garbutt, Jane
描述健康足月婴儿早期和长期黄疸的初级保健管理，以确定增加胆汁淤积早期诊断的机会。密苏里州圣刘易斯的社区儿科医生完成了一项邮寄的、匿名的29项调查，以评估实践人口统计学、常规新生儿办公室访视的时间以及早期和长期新生儿黄疸的管理。108/230（47%）符合条件的医生回答（平均执业年数，15.3，SD，9.4）。更多的受访者非常熟悉国家的指导方针，管理早期（49%）比长期（16%）新生儿黄疸。86%的新生儿在出院前接受了经皮胆红素（TcB）检查。对于48小时TcB结果为7、10、12和15 mg/dL，分别有1%、25%、69%和73%的受访者会订购分级胆红素。虽然第一次常规访视通常发生在出院后的第一周，但25%的医生报告第二次访视通常安排在4周龄后。92%的人报告说，他们将为4周龄以上的黄疸婴儿获得分级胆红素。如果在6周龄时发现胆汁淤积，32%的人将获得额外的测试，而无需转诊给专科医生。新生儿黄疸早期和长期的管理是可变的。目前的做法似乎错过了早期诊断胆汁淤积和转诊的机会，如果不重新设计护理系统，这些问题就不可能得到解决。
To describe primary care management of early and prolonged jaundice in otherwise healthy term infants to identify opportunities to increase early diagnosis of cholestasis. Community-based pediatricians in St Louis, MO completed a mailed, anonymous 29-item survey to assess practice demographics, timing of routine newborn office visits and management of early and prolonged neonatal jaundice. 108/230 (47%) of eligible physicians responded (mean years in practice, 15.3, SD, 9.4). More respondents were very familiar with national guidelines for management of early (49%) than prolonged (16%) neonatal jaundice. Eighty six percent reported all newborns were checked with transcutaneous bilirubin (TcB) before hospital discharge. For TcB results at 48 hours of 7, 10, 12 and 15mg/dL, 1%, 25%, 69% and 73% of respondents respectively would order a fractionated bilirubin. While the first routine visit usually occurred in the first week after discharge, 25% of physicians reported the 2nd visit was routinely scheduled after 4 weeks of age. Ninety-two percent reported they would obtain a fractionated bilirubin for infants jaundiced beyond 4 weeks of age. If cholestasis was identified at 6 weeks of age, 32% would obtain additional testing without referral to a subspecialist. Management of early and prolonged neonatal jaundice is variable. Current practices appear to miss opportunities for early diagnosis of cholestasis and referral that are unlikely to be addressed without redesigning systems of care.
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