Recurrence of kernicterus in term and near-term infants in Denmark
Recurrence of kernicterus in term and near-term infants in Denmark
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DOI：
10.1080/080352500750027592
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发表时间：
2000-10-01
期刊：
影响因子：
3.8
通讯作者：
Ebbesen, F
中科院分区：
文献类型：
--
作者：
Ebbesen, F
经典的急性胆红素脑病（核黄疸）在足月和近期婴儿中，直到1994年才在丹麦被发现。然而，从1994年到1998年，确诊了6例。高胆红素血症的病因是已知的两个婴儿；球形红细胞增多症和半乳糖血症，最可能发生在两个婴儿身上；可能是A-O型血免疫，两名婴儿未知。然而，最后提到的一个婴儿的胎龄只有36周。血浆总胆红素最大浓度为531 ~ 745 μ mol/L。核黄疸病例数的增加被认为是由以下原因引起的：(i)对病理体征的认识下降，（ii）胆红素脑病风险评估的变化，（iii）婴儿从产科病房提前出院，（iv）所谓的母乳喂养相关黄疸，(v)胆红素是一种抗氧化剂的证明，以及（vi）难以估计某些移民群体的黄疸程度。因此，为了预防：(a)尝试改变保健工作者对胆红素脑病风险的认识，(b)在产妇出院前向母亲提供进一步的口头和书面指示，(c)更自由地提供婴儿配方奶粉补充剂，(d)在早期阶段由社区护士进行家访，(e)遵循经批准的光疗和换血指南，(f)降低血浆胆红素浓度限值，作为光疗和交换输血的指示；(g)对所有足月和近期婴儿进行筛查；(h)用一种校正皮肤黑色素含量的装置测量皮肤的黄色。结论：对6例病例的审计表明，如果要避免核黄疸的风险，在初级和二级卫生保健部门都有必要采取措施。筛查可以考虑，但为了确定问题，首先应进行更大规模的前瞻性研究，对所有出现血浆胆红素浓度高于交换输血限制的足月和近期出生的新生儿进行审计。
Classical acute bilirubin encephalopathy (kernicterus) in term and near-term infants had not been seen in Denmark for at least 20 y until 1994. From 1994 to 1998, however, six cases were diagnosed. Aetiology of the hyperbilirubinaemia was known in two infants; spherocytosis and galactosaemia, most likely known in two infants; possible A-O blood type immunization, and unknown in two infants. However, one of these last-mentioned infants had a gestational age of only 36 wk. The maximum plasma total bilirubin concentrations were 531-745 mu mol/L. The increase in the number of cases of kernicterus was considered to have been caused by: (i) a decreased awareness of the pathological signs, (ii) a change in the assessment of the risk of bilirubin encephalopathy, (iii) early discharge of the infants from the maternity ward, (iv) so-called breastfeeding-associated jaundice, (v) demonstration of bilirubin being an antioxidant, and (vi) difficulty in estimating the degree of jaundice in certain groups of immigrants. Accordingly, for prevention: (a) Attempt to change the healthcare workers' understanding of the risk of bilirubin encephalopathy, (b) give further instructions, both orally and in writing, to mothers before discharge from the maternity ward, (c) be more liberal in giving infant formula supplements, (d) conduct home visits by the community nurse at an earlier stage, (e) follow authorized guidelines for phototherapy and exchange transfusion, (f) lower plasma bilirubin concentration limits as an indication for phototherapy and exchange transfusion, (g) screen all term and near-term infants, and (h) measure the skin's yellow colour with a device that corrects for the skin's melanin content.Conclusions: Audit of the six cases presented indicates that measures are necessary in both the primary and secondary healthcare sectors if the risk of kernicterus is to be avoided. Screening may be considered, but in order to identify the problems it would first be reasonable to perform a larger prospective study in which audit is performed on all newborn infants, born at term and near-term, who develop a plasma bilirubin concentration above the exchange transfusion limit.