背景:美国儿科学会和加拿大儿科协会都建议所有新生儿在出院前应进行胆红素筛查,这已经成为两国的标准做法。然而,美国预防工作组没有发现强有力的证据表明,这种胆红素普遍筛查的做法可减少胆红素诱发的神经功能障碍或脑白质黄疸等重要结局的发生.
目的:评估经皮筛查与目测检查高胆红素血症的有效性,以防止新生儿(妊娠超过35周的婴儿)再次接受光疗。
方法:我们搜索了CENTRAL,MEDLINE,Embase,CINAHL,ClinicalTrials.gov,ICTRP,和ISRCTN在2023年6月。我们还搜查了会议记录,以及纳入研究的参考清单。
方法:我们纳入了随机对照试验(RCT),准随机化,集群随机化,或与对照组进行前瞻性队列研究,以评估出院前新生儿经皮胆红素(TcB)筛查高胆红素血症的使用。
方法:我们使用了Cochrane预期的标准方法学程序。我们使用具有风险比(RR)和95%置信区间(CI)的分类数据和平均值的固定效应模型评估治疗效果。标准偏差(SD),和连续数据的平均差(MD)。我们使用等级方法来评估证据的确定性。
结果:我们确定了一个符合纳入标准的RCT(1858名参与者)。该研究包括1858名非洲新生儿,他们在妊娠35周或以上,在婴儿托儿所接受常规护理,并在出院前随机招募接受TcB筛查。该研究具有良好的方法学质量。新生儿高胆红素血症的TcB筛查与视觉评估:-可能会降低高胆红素血症的再入院率(RR0.25,95%CI0.14至0.46;P<0.0001;中度确定性证据);-可能对交换输血率影响很小或没有影响(RR0.20,95%CI0.01至14.16;低确定性证据);-可能会增加需要接受光治疗的新生儿数量(中度RR至2.67%CI)。-可能对急性胆红素脑病的发生率影响很小或没有影响(RR0.33,95%CI0.01至8.18;低确定性证据)。该研究未评估或报告护理费用。
结论:中度确定性证据表明,与目视检查相比,TcB筛查可降低高胆红素血症的再入院率。低确定性证据还表明,与目视检查相比,TcB筛查可能对交换输血率影响很小或没有影响。然而,中度确定性证据表明,与目视检查相比,TcB筛查可能会增加出院前需要光疗的新生儿数量.低确定性证据表明,与目视检查相比,TcB筛查可能对急性胆红素脑病的发生率影响很小或没有影响。鉴于我们只确定了一个RCT,需要进一步的研究来确定TcB筛查是否有助于减少新生儿高胆红素血症的再入院和并发症.在新生儿出院后随访有限的情况下,在出院前确定有严重高胆红素血症风险的新生儿对于计划这些婴儿的针对性随访非常重要.
The American Academy of Pediatrics and the Canadian Paediatric Society both advise that all newborns should undergo bilirubin screening before leaving the hospital, and this has become the standard practice in both countries. However, the US Preventive Task Force has found no strong evidence to suggest that this practice of universal screening for bilirubin reduces the occurrence of significant outcomes such as bilirubin-induced neurologic dysfunction or kernicterus.
To evaluate the effectiveness of transcutaneous screening compared to visual inspection for hyperbilirubinemia to prevent the readmission of newborns (infants greater than 35 weeks\' gestation) for phototherapy.
We searched CENTRAL, MEDLINE, Embase, CINAHL, ClinicalTrials.gov, ICTRP, and ISRCTN in June 2023. We also searched conference proceedings, and the reference lists of included studies.
We included randomized controlled trials (RCTs), quasi-randomized, cluster-randomized, or prospective cohort studies with control arm that evaluated the use of transcutaneous bilirubin (TcB) screening for hyperbilirubinemia in newborns before hospital discharge.
We used standard methodologic procedures expected by Cochrane. We evaluated treatment effects using a fixed-effect model with risk ratio (RR) and 95% confidence intervals (CI) for categorical data and mean, standard deviation (SD), and mean difference (MD) for continuous data. We used the GRADE approach to evaluate the certainty of evidence.
We identified one RCT that met our inclusion criteria. The study included 1858 African newborns at 35 weeks\' gestation or greater who were receiving routine care at a well-baby nursery, and were randomly recruited prior to discharge to undergo TcB screening. The study had good methodologic quality. TcB screening versus visual assessment of hyperbilirubinemia in newborns: - probably reduces readmission to the hospital for hyperbilirubinemia (RR 0.25, 95% CI 0.14 to 0.46; P < 0.0001; moderate-certainty evidence); - may have little or no effect on the rate of exchange transfusion (RR 0.20, 95% CI 0.01 to 14.16; low-certainty evidence); - probably increases the number of newborns who require phototherapy prior to discharge (RR 2.67, 95% CI 1.56 to 4.55; moderate-certainty evidence). - may have little or no effect on the rate of acute bilirubin encephalopathy (RR 0.33, 95% CI 0.01 to 8.18; low-certainty evidence). The study did not evaluate or report cost of care.
Moderate-certainty evidence suggests that TcB screening probably reduces hospital readmission for hyperbilirubinemia compared to visual inspection. Low-certainty evidence also suggests that TcB screening may have little or no effect on the rate of exchange transfusion compared to visual inspection. However, moderate-certainty evidence suggests that TcB screening probably increases the number of newborns that require phototherapy before discharge compared to visual inspection. Low-certainty evidence suggests that TcB screening may have little or no effect on the rate of acute bilirubin encephalopathy compared to visual inspection. Given that we have only identified one RCT, further studies are necessary to determine whether TcB screening can help to reduce readmission and complications related to neonatal hyperbilirubinemia. In settings with limited newborn follow-up after hospital discharge, identifying newborns at risk of severe hyperbilirubinemia before hospital discharge will be important to plan targeted follow-up of these infants.