日本新生児成育医学会雑誌　第27巻第2号　95～100頁（2015年）

日本新生児成育医学会雑誌 27(2)：299-304；2015　

受付日：平成26．12．04

受理日：平成27．04．22

我が国の超早産児に対する黄疸管理と治療の現状

Current Management and Treatment for Neonatal Jaundice in Extremely Preterm Infants in Japan

新生児黄疸管理研究会

Japan Neonatal Jaundice Study Group, Japan

森岡一朗・中村　肇・香田　翼・横田知之・岡田　仁・片山義規・國方徹也・近藤昌敏・中村　信・細野茂春・安田真之・横山直樹・和田　浩・伊藤　進・船戸正久・山内芳忠・李　容桂・米谷昌彦

Ichiro MORIOKA，Hajime NAKAMURA，Tsubasa KODA，Tomoyuki YOKOTA，Hitoshi OKADA， Yoshinori KATAYAMA，Tetsuya KUNIKATA，Masatoshi KONDO，Makoto NAKAMURA，Shigeharu HOSONO， Saneyuki YASUDA，Naoki YOKOYAMA，Hiroshi WADA，Susumu ITOH，Masahisa FUNATO， Yoshitada YAMAUCHI，Yong Kye LEE，Masahiko YONETANI

Key Words：extremely preterm infants，kernicterus，Japan，total bilirubin，unbound bilirubin

目的：近年我が国において，超早産児の核黄疸の症例報告が増えている。そこで，現在我が国で行われている超早産児の黄疸管理と治療の現状を明らかにするために全国調査を行った。
対象・方法：全国の総合および地域周産期センター233 施設に超早産児の黄疸治療の現状と管理方法の実際に関する調査用紙を送付し，149 施設から回答を得（回収率：64％），解析を行った。
結果：対象の超早産児の総数は1,599 で，該当年の超早産児出生数の60％を占めた。生後14 ～ 27 日で27.6％，28日以降で10.7％の児に光線療法（光療法）が施行されていたが，4 人に核黄疸が発症していた。黄疸管理としては，血清総ビリルビン（TB）測定でのみ評価している施設が最も多かった（44％）。生後2 週以降の測定の基準は，53％の施設で主治医の判断で行われ，特に基準は定められていなかった。
結論：現在の主流である不定期にTB 測定を行う黄疸管理では，超早産児の核黄疸の発生を予防するには十分ではない可能性がある。

Background：The reports of kernicterus in extremely preterm infants have recently increased in Japan, and it is diagnosed on the basis of clinical findings during the neonatal and infancy periods. We aimed to investigate the current situation of management and treatment for neonatal jaundice in extremely preterm infants in Japanese neonatal intensive care units（NICUs）.
Methods：A nationwide mail survey was performed in October 2013 at 233 certified NICUs for neonatology by the Japan Society of Perinatal and Neonatal Medicine. The following data were collected from 149 NICUs and analysed：the number of admitted infants and those treated by phototherapy or exchange transfusion after 2 weeks of age during 2011, and infants who subsequently developed kernicterus. Evaluation methods for neonatal jaundice in extremely preterm infants and criteria for measurement of serum bilirubin in infants after 2 weeks of age were also recorded.
Results：A total of 1,599 infants were analysed, representing 60％（1,599/2,667）of all extremely preterm live births in Japan in 2011. Twenty-eight percent of infants received phototherapy between 14 and 27 days of age and 11％ received phototherapy after 28 days of age. Only one infant received exchange transfusion. Four infants developed kernicterus in infancy. The proportion of NICUs where infants were evaluated for neonatal jaundice by only total serum bilirubin levels was 44％. In 53％ of participating NICUs, serum bilirubin measurements in infants after 2 weeks of age were performed according to no particular criteria.
Conclusion：Irregular serum total bilirubin measurement is the major method of management of neonatal jaundice for extremely preterm infants after 2 weeks of age in Japan. Current Japanese management for neonatal jaundice may not be sufficient to prevent development of kernicterus in extremely preterm infants.