背景:强化光疗(IPT)和交换输血(ET)是极端高胆红素血症的主要治疗方法。然而,没有可靠的证据确定这些治疗的阈值.这项多中心研究比较了IPT和ET治疗极端高胆红素血症的有效性和并发症。
方法:这项回顾性队列研究于2015年1月至2018年1月在7个中心进行。包括符合ET标准的极端高胆红素血症患者。患者分为三个亚组(低,medium-,和高风险)根据孕周和风险因素。在治疗前进行倾向评分匹配(PSM)以平衡数据。研究结果包括胆红素脑病的发展,住院时间,费用,和并发症。死亡率,听觉并发症,癫痫发作,釉质发育不良,眼运动障碍,动脉粥样硬化,电机,在3岁时的随访中评估了语言发育。
结果:本研究共纳入1164例患者。PSM之后,将仅IPT组的296例患者和IPT加ET组的296例患者进一步分为低,medium-,和高风险亚组,有188、364和40名匹配患者,分别。在发病率方面,仅IPT组和IPT加ET组之间没有发现显着差异。并发症,和后遗症。仅IPT组的中低风险亚组的住院时间和费用较低。
结论:在这项研究中,我们的结果表明,IPT是治疗极端高胆红素血症的一种安全有效的方法.高胆红素血症患者的ET指征可能更严格。然而,IPT开始后,有必要制定紧急ET的应急计划,特别是对于有危险因素的婴儿。如果IPT可以得到保证并被证明是治疗性的,应尽可能避免使用ET。
BACKGROUND: Intensive phototherapy (IPT) and exchange transfusion (ET) are the main treatments for extreme hyperbilirubinemia. However, there is no reliable evidence on determining the thresholds for these treatments. This multicenter
study compared the effectiveness and complications of IPT and ET in the treatment of extreme hyperbilirubinemia.
METHODS: This retrospective cohort
study was conducted in seven centers from January 2015 to January 2018. Patients with extreme hyperbilirubinemia that met the criteria of ET were included. Patients were divided into three subgroups (low-, medium-, and high- risk) according to gestational week and risk factors. Propensity score matching (PSM) was performed to balance the data before treatment.
Study outcomes included the development of bilirubin encephalopathy, duration of hospitalization, expenses, and complications. Mortality, auditory complications, seizures, enamel dysplasia, ocular motility disorders, athetosis, motor, and language development were evaluated during follow-up at age of 3 years.
RESULTS: A total of 1164 patients were included in this
study. After PSM, 296 patients in the IPT only group and 296 patients in the IPT plus ET group were further divided into the low-, medium-, and high-risk subgroups with 188, 364, and 40 matched patients, respectively. No significant differences were found between the IPT only and IPT plus ET groups in terms of morbidity, complications, and sequelae. Hospitalization duration and expenses were lower in the low- and medium-risk subgroups in the IPT only group.
CONCLUSIONS: In this
study, our results suggest that IPT is a safe and effective treatment for extreme hyperbilirubinemia. The indication of ET for patients with hyperbilirubinemia could be stricter. However, it is necessary to have a contingency plan for emergency ET as soon as IPT is commenced especially for infants with risk factors. If IPT can be guaranteed and proved to be therapeutic, ET should be avoided as much as possible.