Systematic review of screening for bilirubin encephalopathy in neonates.

摘要: CONTEXT: Severe neonatal hyperbilirubinemia is associated with chronic bilirubin encephalopathy (kernicterus). OBJECTIVE: To systematically review the effectiveness of specific screening modalities to prevent encephalopathy. METHODS: We identified studies through Medline searches, perusing reference lists and by consulting US Preventive Services Task Force lead experts. included English-language publications evaluating effects for using early total serum (TSB), transcutaneous (TcB) measurements, or risk scores. was used as a surrogate possible encephalopathy, because no directly evaluated latter an outcome. calculated sensitivity specificity TSB, TcB scores in detecting hyperbilirubinemia. RESULTS: Ten (11 studies) were eligible. Seven (2 prospective) ability factors (n = 3), TSB 2), combinations 1) predict (typically > 95th hour-specific percentile 24 hours 30 days postpartum). Screening had good detect hyperbilirubinemia: reported area-under-the-curve values ranged between 0.69 0.84, sensitivities specificities suggested similar diagnostic ability. Indirect evidence from 3 descriptive uncontrolled suggests favorable associations initiation decrease rates, rates treatment readmissions compared baseline screening. No study assessed harms CONCLUSIONS: Effects on are unknown. Although can hyperbilirubinemia, there robust suggest that clinical outcomes.