Enfermedad hemolítica por incompatibilidad ABO y desarrollo de ictericia grave en recién nacidos de término: factores predictivos precoces
Introducción. El alta hospitalaria precoz ha incrementado el riesgo de desarrollar ictericia grave en recién nacidos de término (RNT) con enfermedad hemolítica por incompatibilidad ABO. Objetivos. a) Identificar factores que permitan predecir el desarrollo de ictericia grave (que requiere fototerapi...
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| Published in | Archivos argentinos de pediatría Vol. 107; no. 1; pp. 16 - 25 |
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| Main Authors | , , , , , , |
| Format | Journal Article |
| Language | Portuguese Spanish |
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Sociedad Argentina de Pediatría
01.02.2009
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| Abstract | Introducción. El alta hospitalaria precoz ha incrementado el riesgo de desarrollar ictericia grave en recién nacidos de término (RNT) con enfermedad hemolítica por incompatibilidad ABO. Objetivos. a) Identificar factores que permitan predecir el desarrollo de ictericia grave (que requiere fototerapia), en la primera semana de vida; b) analizar la capacidad predictiva de la bilirrubina indirecta (BI) determinada entre las 24 y 36 h para predecir el desarrollo de ictericia grave entre el 2º y el 7º días de vida. Material y métodos. Posterior al consentimiento informado, se realizaron determinaciones de laboratorio entre las 24 y 36 h, 3º, 4º-5º y 6º-7º días de vida. La capacidad predictiva de la BI entre las 24 y 36 h se evaluó mediante el análisis de la curva de eficacia diagnóstica (ROC) y la determinación de la sensibilidad, especificidad, valor predictivo positivo (VPP) y negativo (VPN) de distintos valores límite de BI. Resultados. Ciento setenta y dos (172) de 1.263 RNT (13,6%) presentaron incompatibilidad ABO. Se incluyeron 126 niños, de los cuales 28 (22%) presentaron ictericia grave. Estos últimos presentaron valores de BI entre las 24 y 36 h más elevados que aquellos RNT que no desarrollaron ictericia grave. Se excluyeron 46 niños (33 sin consentimiento, 11 controles incompletos y 2 por razones clínicas). Un valor de BI ≥8,75 mg% entre las 24 y 36 h fue el punto de corte que presentó la menor tasa de clasificación incorrecta: sensibilidad 78%, especificidad 83%, VPP 45% y VPN 95%. Conclusiones. La BI entre las 24 y 36 h de vida, contribuiría a identificar a los recién nacidos a término con incompatibilidad ABO que presentan un riesgo mayor de presentar ictericia grave entre el 2º y el 7º días de vida. |
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| AbstractList | Introducción. El alta hospitalaria precoz ha incrementado el riesgo de desarrollar ictericia grave en recién nacidos de término (RNT) con enfermedad hemolítica por incompatibilidad ABO. Objetivos. a) Identificar factores que permitan predecir el desarrollo de ictericia grave (que requiere fototerapia), en la primera semana de vida; b) analizar la capacidad predictiva de la bilirrubina indirecta (BI) determinada entre las 24 y 36 h para predecir el desarrollo de ictericia grave entre el 2º y el 7º días de vida. Material y métodos. Posterior al consentimiento informado, se realizaron determinaciones de laboratorio entre las 24 y 36 h, 3º, 4º-5º y 6º-7º días de vida. La capacidad predictiva de la BI entre las 24 y 36 h se evaluó mediante el análisis de la curva de eficacia diagnóstica (ROC) y la determinación de la sensibilidad, especificidad, valor predictivo positivo (VPP) y negativo (VPN) de distintos valores límite de BI. Resultados. Ciento setenta y dos (172) de 1.263 RNT (13,6%) presentaron incompatibilidad ABO. Se incluyeron 126 niños, de los cuales 28 (22%) presentaron ictericia grave. Estos últimos presentaron valores de BI entre las 24 y 36 h más elevados que aquellos RNT que no desarrollaron ictericia grave. Se excluyeron 46 niños (33 sin consentimiento, 11 controles incompletos y 2 por razones clínicas). Un valor de BI ≥8,75 mg% entre las 24 y 36 h fue el punto de corte que presentó la menor tasa de clasificación incorrecta: sensibilidad 78%, especificidad 83%, VPP 45% y VPN 95%. Conclusiones. La BI entre las 24 y 36 h de vida, contribuiría a identificar a los recién nacidos a término con incompatibilidad ABO que presentan un riesgo mayor de presentar ictericia grave entre el 2º y el 7º días de vida. |
| Author | Covas, María del C. Alda, Ernesto Esandi, María E. Ventura, Silvia Giuliano, Antonio Gamero, Dora Medina, María S. |
| AuthorAffiliation | Hospital Privado del Sur Servicio de Neonatología |
| AuthorAffiliation_xml | – name: Hospital Privado del Sur – name: Servicio de Neonatología |
| Author_xml | – sequence: 1 givenname: María del C. surname: Covas fullname: Covas, María del C. organization: Servicio de Neonatología – sequence: 2 givenname: María S. surname: Medina fullname: Medina, María S. organization: Servicio de Neonatología – sequence: 3 givenname: Silvia surname: Ventura fullname: Ventura, Silvia organization: Servicio de Neonatología – sequence: 4 givenname: Dora surname: Gamero fullname: Gamero, Dora organization: Hospital Privado del Sur – sequence: 5 givenname: Antonio surname: Giuliano fullname: Giuliano, Antonio organization: Servicio de Neonatología – sequence: 6 givenname: María E. surname: Esandi fullname: Esandi, María E. organization: Servicio de Neonatología – sequence: 7 givenname: Ernesto surname: Alda fullname: Alda, Ernesto organization: Servicio de Neonatología |
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| DocumentTitleAlternate | ABO hemolytic disease and developing of significant hyperbilirubinemia in term newborns: early predictive factors |
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| Keywords | Ictericia neonatal Neonatal jaundice Early discharge ABO incompatibility Alta precoz Incompatibilidad ABO |
| Language | Portuguese Spanish |
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| Title | Enfermedad hemolítica por incompatibilidad ABO y desarrollo de ictericia grave en recién nacidos de término: factores predictivos precoces |
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