Yenidoğanda indirekt hiperbilirubinemi tanı ve tedavisi

ndirekt hiperbilirubinemiye bağlı yenidoğan sarılığı term ve preterm bebeklerde çok sık görülmektedir. Yenidoğan sarılığı tedavisinde amaç bilirubinin beyne zarar verecek düzeylere çıkmasını önlemek ve yüksek bilirubin düzeylerini hızla düşürmektir. Bu amaçla, yenidoğanlar taburculuk öncesi sarılık açısından değerlendirilmeli, annelere iyi bir emzirme eğitimi verilmeli ve takip planı yapılmalıdır. Sarılık saptanan bebeklerde serum total bilirubin ve/veya transkutan bilirubin ölçümü ile risk bölgesi değerlendirilmeli ve Türk Neonatoloji Derneği rehberi eşliğinde postnatal yaş ve risk faktörlerine göre serum total bilirubin düzeyi fototerapi eşik değerine ulaşmış ise fototerapi başlanmalıdır. Serum total bilirubin düzeyi kan değişim sınırına ≤3 mg/dl yakın veya bilirubin artış hızı saatte 0,5 mg/dl’yi geçiyor ise yoğun fototerapi başlanılması, fototerapi eşik değerinde ise standart fototerapi ile tedavi edilmesi uygundur. Fototerapi etkinliği için 4-6 saat sonra bilirubin düzeyi ölçülmeli, bilirubin değeri fototerapi eşik değerinin yaklaşık 3 mg/dl altına düşmüş ise fototerapi kesilmeli ve 12-24 saat sonra rebound bilirubin düzeyi ölçülmelidir. Yoğun fototerapiye rağmen bilirubin düzeyi artıyor ve postnatal yaş ve risk faktörlerine göre kan değişimi eşik değerine ulaşmışsa ya da akut bilirubin ensefalopati bulguları varsa tecrübeli kişilerce, yoğun bakım şartlarında uygun kan ile acil kan değişimi yapılmalıdır.

Diagnosis and therapy of neonatal indirect hyper bilirubinemia

Neonatal jaundice due to unconjugated hyperbilirubinemia is very common in term and preterm infants. The aim of the therapy of neonatal jaundice is to prevent the elevation of bilirubin levels that will be harmful to the brain and to rapidly decrease increased bilirubin levels. For this purpose, newborns should be evaluated for jaundice before discharge, a good breastfeeding education should be given to mothers and a follow-up plan should be made. Infants with jaundice should be evaluated by serum total bilirubin and/or transcutaneous bilirubinometry measurement and if bilirubin level reaches the phototherapy (PT) threshold according to postnatal age and risk factors accompanied by Turkish Neonatal Society guideline, PT should be started. If bilirubin level is close to the exchange transfusion (ET) limit of approximately 3 mg/dl or if bilirubin increase rate exceeds 0.5 mg/dl per hour, it is appropriate to start intensive PT. If bilirubin reaches the threshold of PT, treatment with standard PT is appropriate. The bilirubin level should be measured after 4 to 6 hours for PT activity, if bilirubin value has dropped to approximately 3 mg/dl below the PT threshold, PT should be discontinued and rebound bilirubin level should be measured after 12-24 hours. In spite of intensive PT, if bilirubin level increases and reaches the ET threshold according to postnatal age and risk factors, or if there are signs of acute bilirubin encephalopathy, emergency ET should be performed by individuals experienced in this field with appropriate blood in the intensive care setting.

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