| 摘要: | 生理性新生兒的高膽紅素血症治療目前仍是以照光治療為主要治療的方式，而極低體重兒與早產兒更比足月兒更易發生高膽紅素血症，然而密集的監測也很重要，以避免發生神經病變以及核黃疸的可能性。黃疸照光方式治療方式目前臨床上的主流方式是，除了餵食以外皆是採取持續性照光，而往往這也會間接阻斷想哺餵母乳或是新手媽媽想要學習如何照顧新生兒的衛教知識與哺餵母乳技巧。
本篇研究以系統性文獻回顧與統合分析來評估持續性與間接性照光治療對於新生兒與早產兒的效益。經由 PubMed、Embase 及 Cochrane、Google scholar資料庫篩選，收納了有關比較持續性與間接性照光治療對於新生兒、早產兒與極低體重兒的效益的研究分析。並進一步探討分析間接性照光治療的效益以及副作用的比較。
結果顯示在間接性照光中相較於對照組持續性照光對於降低血清膽紅素質是有相同的效益。在不同的時段，於12小時後間接組與持續組的血清膽紅素量的 MD為0.13 ; (95%CI為-0.28至0.54)。於24 小時後間接組與持續組的血清膽紅素量的MD為0.08 (95%CI為-0.72至0.56)。於36小時後間接組與持續組的血清膽紅素量的MD為0.05 (95%CI為-0.19至0.09)。結果在這三個不同時段，於膽紅素降低質量無顯著差異。而在副作用中，結論是沒有統計上之意義，在排便次數上雖然是對照組持續性照光多於間接性照光組，出現發燒、起疹子兩組都有出現，但因為個案數較少所以無法實際比較不同的效益。
結論為間接性照光治療相較於持續性照光，對於新生兒與早產兒的效益其實是無險著性差異的，所以搜尋文獻時進而整理分析時發現其實間接性黃膽照光方式也不亞於持續性黃疸照光治療方式。
目前在台灣臨床上在治療新生兒黃疸上仍是以持續性照光治療為主，而照光方式除了基本的在保溫箱照光治療外，還有所謂的黃疸照光床，新生兒脫光衣服睡在床上，除了要注意新生兒體溫以外，還有當母親要來親餵時也不甚方便。期待若能運用在臨床上也可以增加母親哺餵母乳以及袋鼠護理，增加親子關係也間接降低新手父母親的焦慮。日後若能再進行臨床研究，獲得更確實的可信度，與實證研究效果，相信更能推廣在臨床運用上。
The treatment of hyperbilirubinemia in physiological neonates is still based on phototherapy, and very low birth weight and premature infants are more prone to hyperbilirubinemia than full-term infants. However, intensive monitoring is also important to avoid the possibility of neuropathy and kernicterus. The current clinical mainstream treatment of jaundice is to use continuous phototherapy in addition to feeding, and often this will indirectly block the health education knowledge of breastfeeding or novice mothers who want to learn how to take care of newborns and breastfeeding tips.
In this study, a systematic literature review and meta-analysis were performed to assess the benefits of continuous and intermittent phototherapy for newborns and preterm infants. After screening PubMed, Embase, Cochrane, and Google scholar databases, the research analyzes the effectiveness of continuous and intermittent phototherapy for neonates, premature infants, and very low birth weight infants were included. And further, explore and analyze the comparison of the benefits and side effects of intermittent phototherapy.
The results showed that compared with the control group, continuous phototherapy had the same effect on reducing serum bilirubin quality in intermittent phototherapy. In different periods, the mean difference of serum bilirubin at 12 hours, 24 hours, and 36 hours was 0.13 (95% CI: -0.28 to 0.54), 0.02 (95% CI: -0.63 to 0.60 ) and 0.02 ( 95% CI: -0.63 to 0.60). The results showed no significant difference in the reduction of bilirubin in these three different periods. In terms of side effects, the conclusion is not statistically significant. In terms of the number of bowel movements, although the continuous phototherapy exposure group in the control group was more than the intermittent phototherapy exposure group, fever and rash occurred in both groups, it is not practical because of the small number of cases. Compare different benefits.
The conclusion is that compared with continuous phototherapy, there is no significant difference in the benefits of indirect light therapy for neonates and premature infants. Therefore, when searching the literature and analyzing it, it is found that intermittent phototherapy for jaundice is no less effective than continuous phototherapy. Currently, in Taiwan, continuous phototherapy is still the main treatment for neonatal jaundice in clinical practice. Besides the basic incubator, there is a so-called jaundice phototherapy bed. Newborns sleep on the bed with their clothes off, and the newborn’s body temperature is being monitored, but it is inconvenient when the mother comes to breastfeeding. It is expected that if it can be applied clinically, it can also increase breastfeeding and kangaroo care for mothers, increase the parent-child relationship and indirectly reduce the anxiety of novice parents. If clinical research can be carried out in the future to obtain more reliable credibility and empirical research results, I believe it can be more popularized in clinical applications。 |
