青铜症和核黄疸危险

作     者：Bertini G. Dani C. Fonda C. 郭战宏 

作者机构：Department of Critical Care Medicine and Surgery University of Florence Careggi University Hospital VialeMorgagni 85 50134 Firenze Italy 

出 版 物：《世界核心医学期刊文摘（儿科学分册）》 (Dkgest of the World Latest Medical Information)

年 卷 期：2005年第1卷第11期

页      面：21-21页

学科分类：1002[医学-临床医学] 100202[医学-儿科学] 10[医学] 

主　　题：青铜症 核黄疸 换血治疗 胆红素血症 换血疗法 出生后 溶血性疾病 血清总胆红素 交换输血 血细胞比容 

摘      要：Aim: The problem of kernicterus in infants with bronze baby syndrome (BBS) has been reviewed on the basis of cases reported in the literature. In addition, a new case concerning an infant with severe Rh haemolytic disease, who presented with BBS and who has developed neurological manifestations of kernicterus with magnetic resonance images showing basal ganglia abnormalities, is presented. In this patient, the total serum bilirubin (TSB) concentration ranged from 18.0 to 22.8 mg/dl (306 to 388 μmol/l) and the bilirubin/albumin (B/A) ratio was 6.0 (mg/g) (6.8 is the value at which an exchange transfusion should be considered). The case presented is important due to the fact that kernicterus appeared after an exchange transfusion was performed when the TSB level reached 22.8mg/dl (388 μmol/l) on 6th day of life while the haematocrit was 30%. From this case and fromother cases reported in the literature, we must stress that, even if the level at which hyperbilirubinemia poses a threat remains undefined, BBS may constitute an additional risk of developing kernicterus. Conclusion: The possible strategies for implementing an approach to the management of hyperbilirubinemia (especially the haemolytic kind) in the presence of BBS may include an exchange transfusion carried out at lower TSB concentration than previously recommended or an early administration of Sn-mesoporphyrin.