预防早产儿高胆红素血症的临床实践

目的探讨早期综合干预新生儿黄疸对预防高胆红素血症的意义。方法采取回顾性随机抽样方法,对是否实行新生儿黄疸早期干预的两组患儿进行胆红素峰值、高胆红素血症发生率、黄疸消退时间进行对照,探讨其意义。结果干预组、对照组高胆红素血症发病率分别为6.25%和32.5%,两组对比有显著性差异(P<0.05)。结论对早产儿黄疸进行早期综合干预,可积极预防高胆红素血症的发生。     

新生儿外周动静脉同步换血疗法16例护理体会

目的探讨外周动静脉同步换血疗法治疗新生儿溶血症和高胆红素血症的效果和护理方法。方法联合采用输液泵及注射泵对16例新生儿溶血症和高胆红素血症进行同步外周动静脉换血疗法。结果16例患儿全部穿刺成功并顺利完成换血,除早期2例患儿因换血速度快出现短时间的心率增快、血压升高、烦躁、哭闹外,未出现并发症。换血结束后血清胆红素浓度下降均≥50%。结论新生儿外周动静脉同步换血疗法换血速度的快慢可影响患儿的生命体征和换血的进行;经外周动静脉穿刺成功率高、并发症少、治疗效果好,同时把握好确当的换血速度,是一项值得推广的护理技术。     

Utility of icteric index in clinical laboratories: more than a preanalytical indicator

IntroductionTotal bilirubin tests are highly demanded in clinical laboratories. Since icteric index (I-index) has zero cost, we aimed to evaluate its clinical utility and cost-effectiveness to determine if total bilirubin is necessary to be tested. We took into account if haemolysis could interfere to icteric index determination.Material and methodsRetrospectively we reviewed I-index results in two cohorts (43,372 and 8507 non-haemolysed and haemolysed samples, respectively). All determinations were done using Alinity c chemistry analysers (Abbott Diagnostics). Receiver operating characteristic (ROC) curve was used to determine the optimal index cut-off to discriminate between normal and abnormal bilirubin concentration (20.5 µmol/L).ResultsThe ROC curve analysis suggested 21.4 µmol/L as the optimal I-index cut-off but differences in sensitivity and specificity were detected between patient derivation. For rejecting purpose, 15.4 µmol/L and 17.1 µmol/L I-index thresholds were selected based on patient derivation (inpatients and emergency room; and primary care and outpatients, respectively) with 97% sensitivity and 0.25% false negative results. Sensitivity was much lower in haemolysed samples. We selected 34.2 µmol/L I-index as threshold to detect hyperbilirubinemia with 99.7% specificity and 0.26% false positive results, independent of haemolysis. With the icteric index cut-offs proposed, we would save 66% of total bilirubin requested and analyse total bilirubin in around 2% of samples without total bilirubin requested.ConclusionsThis study supports the use of I-index to avoid bilirubin determination and to identify patients with hyperbilirubinemia. This work considers that the economic and test savings could help to increase the efficiency in clinical laboratories.