Can Severe Neonatal Jaundice Be Prevented by Neonatal Screening for Glucose-6-Phosphate Dehydrogenase Deficiency? - A Review of Evidence

新生兒篩檢葡萄糖六磷酸脫氫酶缺乏症是否可以預防嚴重新生兒黃疸？

禇文銘(Wen-Min Chuu) ； 林東燦(Dong-Tsamn Lin) ； 林凱信(Kai-Hsin Lin) ； 陳博文(Bow-Wen Chen) ； 陳榮隆(Rong-Long Chen) ； 林國信(Kuo-Sin Lin)

《Acta Paediatrica Sinica》 37卷5期 (1996/10) Pp. 333-341

https://doi.org/10.7097/APS.199610.0333

摘要

本文採用“證據爲主”之方法，回顧相關文獻，以評估新生兒篩檢G-6-PD之必要性及成效。結果顯示，在較進步之地區，足月兒罹患嚴重黃疸，已很少見；G-6-PD缺乏之新生兒發生黃疸，多不是接觸到外在誘發因素所致，因此無法預防，所以G-6-PD 篩檢之必要性與成效有待重估。在較落後之地區，G-6-PD缺乏症相關之新生兒黃疸，仍然有很高的罹病率及死亡率，而且新生兒接觸到外在誘發因素（如萘丸）的機會仍高，因此在此類地區，或許有施行G-6-PD篩檢之必要，但醫療資源匱乏是其難題；此外，G-6-PD篩檢之成效，也有待進一步研究。過去有些報告，宣稱新生兒篩檢G-6-PD缺乏症，可以減少嚴重黃疸，這些研究未提供自己的對照組，而是採用從前的病例做比較所得之結果，有可能是其他隨時間而改變之混淆因素所産生，而不能一昧歸功於篩檢本身。G-6-PD缺乏症相關之新生兒黃疸，多發生在出生後一週內，因此如做篩檢，G-6-PD之篩檢絕不能與其他篩檢，在出生後數天才做；再者爲求時效，G-6-PD缺乏症，是最常見的遺傳性異常，真陽性及假陽性個案數很多，這些因素都會增加G-6-PD篩檢所需之費用。篩檢通常會伴隨不良影響（如焦慮），目前則尚無相關研究。總之，以目前證據，還無法證明新生兒篩檢G-6-PD缺乏症可以適當有效地預防嚴重新生兒黃疸。

關鍵字

新生兒篩檢 ； 六磷酸葡萄糖脫氫酶缺乏 ； 新生兒黃疸

並列摘要

An evidence-based approach is used to evaluate the neonatal screening program for glucose-6-phosphate dehydrogenase (G-6-PD) deficiency. The primary consideration to include G-6-PD deficiency(G-6-PDD) in neonatal screening program was the public health burden of G-6-PDD-associated neonatal jaundice (G-6-PDDANJ) in the target population. However, the prevalence of G-6-PDD per se cannot be the sole index of the public health burden of G-6-PDDANJ. In more develope4 areas, G-6-PDDANJ is no longer a major public health problem. Further, most cases with G-6-PDDANJ in more developed areas are not precipitated by any identifiable icterogenic agents, and therefore not preventable by avoidance education. In less developed areas, however, G-6-PDDANJ is still a big public health burden and requires intervention. In this study, the effectiveness of neonatal screening programs for G-6-PDD to prevent severe neonatal jaundice (NJ) has been shown based on historical comparison, but the results may be confounded by other temporal factors. G-6-PDDANJ usually occurs in the first week after birth. Prompt need for G-6-PD screening results precludes it from incorporation into other existent neonatal screening programs (i.e., for PKU), and from centralization of laboratory work. The efficacy, adverse effects and cost-effectiveness of this mass screening program need further study.

並列關鍵字

neonatal screening ； glucose-6-phosphate dehydrogenase (G-6-PD) deficiency ； neonatal jaundice