ACW Lee, WT Lung, R Li, H Ng, K Tse, NS Kwong

Abstract

In contrast to the initiation of treatment for neonatal jaundice, specific guidelines for discontinuation of phototherapy and subsequent management of the infants are lacking. The current study aims at documenting the current practice and examining if babies can be discharged from phototherapy without routine evaluation for rebound hyperbilirubinaemia. Between January and May 1998 inclusively, all neonates aged under two weeks with a birth weight >= 2,200 grams admitted for phototherapy were recruited for the study. Babies were excluded if they required intensive care, received parenteral nutrition, or were receiving antibiotics at the time of discontinuation of phototherapy. 154 infants were enrolled. Seven (4.5%) babies required a second course of phototherapy because their SB rebounded into the treatment range. When compared with those babies not requiring treatment again, they had a higher mean SB (234.3 vs 204.1, p<0.001) and were more likely to be younger than five days of life (3/7 vs 16/147, p=0.041) when phototherapy was first stopped. Other factors like sex, cephalhaematoma, glucose 6 phosphate dehydrogenase deficiency, blood groups, Coombs' test, onset of jaundice, and haemoglobin level were not found to be significant. If a threshold of SB <= 216 μmol/L (or 234 μmol/L less 2 standard deviations) were used for discontinuation of phototherapy without routine evaluation for rebound hyperbilirubinaemia, 61% of the "well" babies in this study would have had an earlier discharge. Thus, a more structured guideline on the management of discontinuation of phototherapy is indicated for evaluation of our current practice.

相對於傳統的新生兒黃疸治療方法而言，間斷光照治療及以後對嬰兒管理的特殊方案是較缺乏的。本研究的目的是記錄間斷光照治療的實踐過程，並檢驗嬰兒停止此療法而不需做常規高膽紅素血症反彈評估的可能性。從 1998年1月至5月，所有年齡在2周以下，並且出生體重>=2200g 來做光照療法的新生兒參與了此研究，在間斷光照療法期間需要強化護理，靜脈營養或使用抗菌素的患兒被剔除，其餘共 154名嬰兒參加了本研究。7名嬰兒(4.5%)由於他們的SB水平反彈而需進行第二療程的光療，相對於那些不需第二療程的嬰兒而言，這些病兒的平均SB水平較高(234.3 比204.1，P<0.001)，並且在第一療程結束時這些嬰兒顯得比實際年齡小 5天。其它一些因素如腦血腫，糖-6磷酸脫氫代酶缺乏，血型， Coomb' 氏試驗，黃疸發生時間和血紅蛋白水平在這兩組病兒間無顯著差別，如果選用 SB<=216 μmol/L （或 234 μmol/L 小於2個標准差）作為間斷治療且不需做常規高膽紅素血症反彈評估的界值點，本研究中 61%的「健康」嬰兒會提前出院。因此，需要更富有建設性的關於間斷光療管理的指導方案來評價我們的研究。