Loading...
Publication
Diagnóstico e abordagem terapêutica da hiperbilirrubinémia nos recém-nascidos
| Name: | Description: | Size: | Format: | |
|---|---|---|---|---|
| 1.59 MB | Adobe PDF |
Authors
Advisor(s)
Abstract(s)
A hiperbilirrubinémia caracteriza-se pela elevada concentração de bilirrubina em circulação e é uma das patologias mais comuns em recém-nascidos, sendo umas das principais causas de internamento e readmissão hospitalar nesta população. A bilirrubina é tóxica para o sistema nervoso central, sendo, por isso, fundamental que ocorra uma monitorização cuidadosa, dada as repercussões graves que podem surgir nos bebés, como encefalopatia bilirrubínica e a kernicterus.
A hiperbilirrubinémia pode dividir-se em 2 tipos. A hiperbilirrubinémia não conjugada pode ter etiologia fisiológica ou patológica enquanto a hiperbilirrubinémia conjugada tem sempre etiologia patológica. A etiologia da hiperbilirrubinémia deve ser identificada com o objetivo de determinar a melhor opção terapêutica.
Como forma de diagnosticar esta patologia deve ser realizado o hemograma completo, determinação fenotípica do grupo sanguíneo e o teste de Coombs. Devem também ser determinados os valores da albumina e das aminotransferases séricas e os valores de bilirrubina sérica total. É a partir dos valores de bilirrubina sérica total que se baseia a escolha do tratamento, sendo a fototerapia e a exsanguinotransfusão as principais opções terapêuticas. A fototerapia constitui o tratamento preferencial da hiperbilirrubinémia neonatal, reduzindo a necessidade de recorrer à exsanguinotransfusão.
Foram estabelecidas recomendações quanto à abordagem a adotar no tratamento desta patologia, que incluem a utilização adequada da fototerapia e da exsanguinotransfusão, a necessidade de intensificar os cuidados, a realização de fototerapia no domicílio, a descontinuação dos cuidados e o acompanhamento pós-alta hospitalar.
Atualmente, apesar das recomendações criadas para a abordagem da hiperbilirrubinémia neonatal e o desenvolvimento de novas tecnologias e novas terapêuticas, esta patologia continua a ser uma causa significativa de mortalidade e morbilidade nos recém-nascidos.
Hyperbilirubinemia is characterized by a high concentration of bilirubin in circulation and is one of the most common pathologies in newborns, being one of the main causes of hospitalization and readmission in this population. Bilirubin is toxic to the central nervous system, so careful monitoring is essential, given the serious repercussions that can arise in babies, such as bilirubin encephalopathy and kernicterus. Hyperbilirubinemia can be divided into 2 types. Unconjugated hyperbilirubinemia can have a physiological or pathological etiology, while conjugated hyperbilirubinemia always has a pathological etiology. The etiology of hyperbilirubinemia must be identified to determine the best therapeutic option. To diagnose this pathology, a complete blood count, phenotypic determination of the blood group and the direct antiglobulin test must be performed. Serum albumin and aminotransferase levels and total serum bilirubin levels should also be determined. The choice of treatment is based on total serum bilirubin levels, with phototherapy and exchange transfusion being the main therapeutic options. Phototherapy is the preferred treatment for neonatal hyperbilirubinemia, reducing the need for exchange transfusion. Recommendations have been established regarding the approach to be adopted in the treatment of this condition, which include the appropriate use of phototherapy and exchange transfusion, the need for escalation of care, home phototherapy, discontinuation of care and post discharge follow-up. Currently, despite the recommendations created for the management of neonatal hyperbilirubinemia and the development of new technologies and new therapies, this condition continues to be a significant cause of mortality and morbidity in newborns.
Hyperbilirubinemia is characterized by a high concentration of bilirubin in circulation and is one of the most common pathologies in newborns, being one of the main causes of hospitalization and readmission in this population. Bilirubin is toxic to the central nervous system, so careful monitoring is essential, given the serious repercussions that can arise in babies, such as bilirubin encephalopathy and kernicterus. Hyperbilirubinemia can be divided into 2 types. Unconjugated hyperbilirubinemia can have a physiological or pathological etiology, while conjugated hyperbilirubinemia always has a pathological etiology. The etiology of hyperbilirubinemia must be identified to determine the best therapeutic option. To diagnose this pathology, a complete blood count, phenotypic determination of the blood group and the direct antiglobulin test must be performed. Serum albumin and aminotransferase levels and total serum bilirubin levels should also be determined. The choice of treatment is based on total serum bilirubin levels, with phototherapy and exchange transfusion being the main therapeutic options. Phototherapy is the preferred treatment for neonatal hyperbilirubinemia, reducing the need for exchange transfusion. Recommendations have been established regarding the approach to be adopted in the treatment of this condition, which include the appropriate use of phototherapy and exchange transfusion, the need for escalation of care, home phototherapy, discontinuation of care and post discharge follow-up. Currently, despite the recommendations created for the management of neonatal hyperbilirubinemia and the development of new technologies and new therapies, this condition continues to be a significant cause of mortality and morbidity in newborns.
Description
Keywords
Bilirrubina Hiperbilirrubinémia Icterícia Recém-nascido Terapêutica