Author/Editor		Furlan, Danijela; Žalec, Lidija; Pavlin, Tatjana; Gradecki, Mirjam; Oštir Mevželj, Darinka; Bratanič, Borut
Title		Napoved razvoja hiperbilirubinemije pri donošenih novorojenčkih z neinvazivnimi metodami
Translated title		Prediction of hyperbilirubinemia by noninvasive methods in full-term newborns
Type		članek
Vol. and No.		Letnik 82, št. 3
Publication year		2013
Volume		str. 158-163
ISSN		1581-0224 - Zdravniški vestnik
Language		slv
Abstract		Izhodišča: Izhodišče raziskave je napovedati razvoj patološke hiperbilirubinemije z neinvazivnim pristopom. Zato smo v skupini zdravih donošenih novorojenčkov preverili uporabnost presejalnih metod za določanje koncentracije bilirubina. Primerljivost rezultatov med presejalno (transkutanibilirubinmeter) in potrditveno (Jendrassik-Grof (JG)) metodo bi potrdila uporabo transkutanega določanja bilirubina (TcBIL) v kombinaciji z določitvijo bilirubina v popkovnični krvi (CbBIL) in s tem koristnost uvedbe takega presejalnega postopka v klinično obravnavo neonatalne hiperbilirubinemije. Metode: V raziskavo je bilo vključenih 284 zdravih donošenih novorojenčkov, zaporedno rojenih od marca do junija 2011. Celotna skupina je bila glede na koncentracijo celokupnega bilirubina (220 micromol/L), razdeljena na 2 podskupini: s fiziološko (n=199) in patološko (n=85) hiperbilirubinemijo. Koncentracija CbBIL in v kapilarni krvi 3. dan starosti je bila določena z metodo JG, TcBIL pa z merilnikom Bilicheck. Za statistične analize smo uporabili Kolmogorov-Smirnov test in Mann-Whitney test. Rezultati: Med skupinama novorojenčkov s fiziološko (n=199) in patološko (n=85)hiperbilirubinemijo so bile vse koncentracije bilirubina statistično značilno različne (CbBIL (p< 0,001), kontrolni vzorec 3. dan (p< 0,001), TcBIL(p< 0,001)). Pri mejni vrednosti CbBIL 28 micromol/L lahko z 98,8-odstotno diagnostično občutljivostjo napovemo razvoj patološke hiperbilirubinemije, hkrati pa lahko s 100-odstotno občutljivostjo napovemo, da novorojenčki ne bodo potrebovali fototerapije (zajeti vsi obsevani novorojenčki). Potrdili smo primerljivost med koncentracijami bilirubina določenimi s presejalno in potrditveno metodo za obe primerjani skupini novorojenčkov. Zaključki: Na osnovi rezultatov raziskave lahko predlagamo uvedbo določanja CbBIL v kombinaciji z merjenjem TcBIL za zgodnjo napoved patološke hiperbilirubinemijepri donošenih novorojenčkih. Prednosti obeh presejalnih metod v rutinski klinični obravnavi hiperbilirubinemije sta neinvaziven način izvedbe in nižji stroški obravnave zaradi nepotrebnega podaljševanja hospitalizacije ali ponovnih sprejemov.Introduction: The noninvasive screening methods for bilirubin determination were studied prospectively in a group of full-term healthy newborns with the aim of early prediction of pathological neonatal hyperbilirubinemia. Laboratory determination of bilirubin (Jendrassik- Grof (JG)) was compared to the noninvasive transcutaneous bilirubin (TcBIL) together with the determination of bilirubin in cord blood. Methods: The study group consisted of 284 full-term healthy consecutively born infants in the period from March to June 2011. The whole group was divided into a group of physiological (n=199), and a group of pathological hyperbilirubinemia (n=85) according to the level of total bilirubin (220 micromol/L). Bilirubin in cord blood (CbBIL) and from capillary blood at the age of three days was determined according to the JG, on the 3rd day TcBIL was also detected by Bilicheck bilirubinometer. The Kolmogorov- Smirnov and Mann-Whitney tests were used for the statistical analysis. Results: Bilirubin concentrations were statistically significantly different (CbBIL (p< 0,001) on the 3rd day control sample (p< 0.001), TcBil (p< 0,001)) between the groups of newborns with physiological (n=199) and pathological (n=85) hyperbilirubinemia. Using the cut-off value of cord blood bilirubin 28 micromol/L, we could predict the development of pathological hyperbiliru with 100 % sensitivity that newborns will not require a phototherapy (all irradiated newborns were taken into account). We confirmed an excellent agreement between bilirubin concentrations determined by the TcBIL and JG methods for both groups of healthy full-term newborns. Conclusion: Based on our results, we could recommend that determination of thecord blood bilirubin in combination with the measurement of TcBIL should be implemented into practice for early prediction of pathological hyperbilirubinemia in full-term healthy newborns. The advantages of both methods in the routine clinical treatment of hyperbilirubinemia are in noninvasive approach with reduced costs and number of unnecessary treatments.
Keywords		bilirubin v popkovnični krvi neinvazivne presejalne metode transkutani bilirubin patološka hiperbilirubinemija