美国儿科学会最新新生儿黄疸诊疗指南

···[]2006-06-20[],,,,。李秋平,封志纯(南方医科大学珠江医院儿科,广州510282)TheLatestGuidelineforNeonatalJaundiceProducedbyAmericanAcademicofPediatricsLIQiu-ping,FENGZhi-chun(DepartmentofPediatrics,ZhujiangHospitalofSouthernMedicalUniversity,Guangzhou510282,China)Abstract:Jaundicecanoccurinmostneonates.Mostjaundiceisbenign,butbeacuseofthepotentialtoxicityofbilirubin,newborninfantswithseverehyperbilirubinemiacandevelopacutebilirubinencephalopathyorkernicterus.InOctober2004,Americanacademicofpediatricspro-ducedthelatestguidelinefornewbornjaundiceaimtoreducetheincidenceofacutebilirubinencephalopathyorkernicterusandavoidunnecessarycostsortreatment.Thelatestguidelineemphasizestheimportantofsuccessfulbreastfeeding,timeofjaundicedeveloped,assessmentfortheriskofseverehyperbilirubinemia,closefollow-up,andpromptinterventionwhenindicated,provideaframeworkforthepreventionandmanagementofhyperbilirubinemiainnewborninfantsof35ormoreweeksofgestation.Somenewviewinthelatestguidelinemaybehelpfultous.JApplClinPediatr,2006,21(14):958-960Keywords:infant,newborn;jaundice;guideline;Americanacademicofpediatrics[],,,。,,20048。、、、,,,。,2006,21(14):958-960[]婴儿,新生;黄疸;指南;美国儿科学会[]R722.1　　　[]A　　　[]1003-515X(2006)14-0958-03　　,60%。,,,,。、、、,,,。(AAP)1994[1],2000,[2]。,,50,,,[3]。,,1994,2004≥35[4,5]。、、、,,,。、,,。、。:1.;2.;3.24h(TSB)(TcB);4.,;5.;6.,,,;7.,;8.;9.;10.,。2004　1。,TSBTcB,。1　Figure1　AlgorithmforManagementofJaundiceinNewbornNursery、,。、。2004,。1,·958·211420067　JApplClinPediatr,Vol.21No.14Jul.2006。、,。。,。,8～12/d。。。。,。、。,,、、、、,。(UCB),UCB≤205.2μmol/L(15.0mg/L)。≤220.6μmol/L(12.9mg/L),≤255μmol/L(15.0mg/L),。,,,≤205～255μmol/L。AAP1994。2001TSB。1.,,,。2.,,,。,。、。。Bhutani2840≥36、2000g,35、2500g,、、、4　2,95,。、,2004　1。、,,,,。、、,。2、3d,4～6d。,,。,2004。,,,。、3　2,。,24h,72h;24～48h,96h;48～72h,120h。,。,,。[6]。,,。2　Figure2　NomogramforDesignationofRiskinNeonatalHyperbiliru-binemia1　≥35Table1　LaboratoryEvaluationofJaundicedInfantsof35andMoreWeeks′Gestation24hTSB()TcBTSB()TcBTSB,、Coomb′s、、、、G-6PD、ETCOC,TSB4～24hTSBTSB,、G-6PD、ETCOC,,,3,,?　　、,、、、、3,　3、4。2001。2001。、。,,、,·959·211420067　JApplClinPediatr,Vol.21No.14Jul.2006。()、G-6PD、、、()、、、、、、3g/L,,。,,。2　≥35Table2　RiskFactorsforDevelopmentofSevereHyperbilirubinemiainInfantsof35andMoreWeeksofGestation　　　TSBTcBTSBTcBTSBTcB24h41(+)G-6PD35～3637～3872h,253　35Figure3　GuidelinesforPhototherapyinHospitalizedInfantsof35andMoreWeeks'Gestation4　35Figure4　GuidelinesforExchangeTransfusioninInfantsof35andMoreWeeks'Gestation　　1994,2004,,。199472hTSB20.0mg/L,TSB17.0mg/L,72h18.0mg/L,120h21.0mg/L。,,TSB,。、B/A、、、、、、,,。,,。/(B/A)[7]。,;,;,。,≥38,B/A8.0(mg/dL∶g/L),。35～3738G-6PD,B/A7.2(mg/dL∶g/L),。35～37G-6PD,B/A6.8(mg/dL∶g/L),。2001B/A,B/A,。2004AAP,、,,guidelinechecklist。,。[][1]Americanacademyofpediatrics.Provisionalcommitteeforqualityim-provementandsubcommitteeonhyperbilirubinemia.Practiceparameter:Managementofhyperbilirubinemiainthehealthytermnewborn[J].Pedi-atrics,1994,94(4):558-565.[2]《》　.()[J].,2001,39(3):184-187.[3]JuretschkeLJ.Kernicterus:Stillaconcern[J].NeonatalNetw,2005,24(2):7-19.[4]AmericanAcademyofPediatricsClinicalPracticeGuidelineSubcommitteeonHyperbilirubinemia.Managementofhyperbilirubinemiainthenewborninfant35ormoreweeksofgestation[J].Pediatrics,2004,114(1):297-316.[5]Newguidelineformanagementofhyperbilirubinemiainnewborns[J].AdvNeonatalCare,2004,4(4):225.[6].4[J].,2002,7(3):124-126.[7]AhlforsCE.Criteriaforexchangetransfusioninjaundicednewborns[J].Pediatrics,1994,93(3):488-494.(:)　　《》20064“《》”,20061———。·960·211420067　JApplClinPediatr,Vol.21No.14Jul.2006