Abstract:

Objective To explore the accuracy and reliability of transcutaneous bilirubin（TcB） determination results at different body surface sites in children with hyperbilirubinemia in NICU before，during and after blue light therapy under different total serum bilirubin（TSB） concentrations. Methods Based on convenience sampling，children with hyperbilirubinemia who were admitted to NICU of a tertiary A hospital in Chengdu from March to October，2021 were selected as the investigation subjects，and TcB of forehead，eyebrows，scapula，sternum，back and buttocks were measured in turn within 15 minutes before collecting TSB samples. Paired sample t-test，Pearson correlation analysis，Bland-Altman consistency analysis，sensitivity，specificity and Youden index were used to evaluate the accuracy and reliability of TcB detection results before，during and after blue light therapy under different TSB concentrations. Results 196 children were included，and 310 groups of paired data between TSB and TcB detection results were obtained. Among them，there were 131 groups before blue light therapy，78 groups during blue light therapy and 101 groups after blue light therapy. There were 212 groups with TSB<15 mg/dl（1 mg/dl=17.1 μmol/L），83 groups with TSB<20 mg/dl and 15 groups with TSB>20 mg/dl. Before blue light therapy，there is the good accuracy of TcB in forehead，eyebrow and sternum. During blue light therapy，the accuracy of TcB in the area covered by eyebrows is better;after blue light therapy，TcB results of forehead，scapula，eyebrows and back are more accurate. When TSB<15 mg/dl，the TcB of forehead，scapula，eyebrow and sternum is more accurate and reliable;when 15 mg/dl≤TSB≤20 mg/dl，the results of TcB in the center of eyebrow and sternum are more accurate and reliable;however，when TSB>20 mg/dl，the accuracy and reliability of TcB in all body surface parts are poor. Conclusion The accuracy and reliability of TcB determination results in different parts of children with hyperbilirubinemia in NICU are different in different treatment periods and TSB concentration. When TSB>20 mg/dl，TcB is not recommended as a reference for clinical decision-making.

Key words: Hyperbilirubinemia,Neonate, Bilirubin, Blue Light Therapy, Neonatal Nursing

摘要：

目的 探讨NICU高胆红素血症患儿在蓝光治疗前、中、后及不同血清总胆红素（total serum bilirubin，TSB）浓度下，不同体表部位经皮胆红素（transcutaneous bilirubin，TcB）测定结果的准确性和可靠性。方法 便利选取2021年3月—10月成都市某三级甲等医院NICU收治的高胆红素血症患儿作为调查对象，在采集其TSB标本前15 min内，依次测量其前额、眉心、肩胛、胸骨、腰背部及臀部的TcB。采用配对样本t检验、Pearson相关分析、Bland-Altman一致性分析、灵敏度、特异度和约登指数，评价蓝光治疗前、中、后及不同TSB浓度下，各体表部位TcB测定结果的准确性和可靠性。结果 共纳入196例患儿，获得310组TSB与TcB的配对数据。其中，蓝光治疗前131组，蓝光治疗中78组，蓝光治疗后101组;TSB<15 mg/dl（1 mg/dl=17.1 μmol/L）有212组，15~20 mg/dl有83组，>20 mg/dl有15组。蓝光治疗前，前额、眉心、胸骨部TcB的准确性较高;蓝光治疗期间，仅眉心TcB的准确性较高;蓝光治疗后，前额、眉心、肩胛以及腰背部TcB的准确性均较高。TSB<15 mg/dl时，前额、眉心、肩胛及胸骨部的TcB较准确、可靠;TSB为15~20 mg/dl时，仅眉心和胸骨部的TcB较准确、可靠;TSB>20 mg/dl时，各体表部位TcB测定结果的准确性和可靠性均较差。结论 在不同治疗时期及TSB浓度下，NICU高胆红素血症患儿各体表部位TcB测定结果的准确性和可靠性有所差异，当TSB>20 mg/dl时，不建议将TcB作为临床决策的参考依据。

关键词: 高胆红素血症，新生儿, 胆红素, 蓝光治疗, 新生儿护理