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Routine transcutaneous bilirubin measurements combined with clinical risk factors improve the prediction of subsequent hyperbilirubinemia

Journal of Perinatology volume 29, pages 612–617 (2009)Cite this article

Abstract

Objective:

To evaluate predischarge transcutaneous bilirubin (TcB) measurements combined with risk factors as predictors of the risk of a subsequent total serum bilirubin (TSB) ⩾17 mg per 100 ml (291 μmol l−1).

Study Design:

Routine TcB measurements are obtained daily for all infants in our well baby nursery. We performed a nested case–control study comparing all 75 infants who had been readmitted with TSB ⩾17 mg per 100 ml (291 μmol l−1) between 1 February 2005 and 28 February 2007 with randomly selected controls that had not been readmitted.

Result:

Between 1 February 2005 and 28 February 2007, 11 456 infants were discharged from the well baby nursery. Seventy-five infants (0.65%) were readmitted at a mean age of 110±29.9 h with a TSB⩾17 mg per 100 ml (291 μmol l−1). All received phototherapy. Using logistic regression analysis, three variables were statistically significant for predicting cases: the maximum predischarge TcB percentile group (P<0.0001, adjusted odds ratio (AOR), >95th percentile 148; 95% confidence interval (CI) 21 to >999, AOR 76 to 95th percentile 15; 95% CI 3.1 to 70, AOR 50 to 75th percentile 6.1; 95% CI 1.3 to 28 compared with <50th percentile), exclusive breastfeeding (P<0.0001, AOR 11; 95% CI 3.7 to 34) and gestational age (P=0.0057, AOR 35 to 36 6/7 week 21; 95% CI 2.3 to 185, AOR 37 to 37 6/7 week 15; 95% CI 1.9 to 115, AOR 38 to 38 6/7 week 1.8; 95% CI 0.3 to 11, AOR 39 to 39 6/7 week 1.1; 95% CI 0.2 to 7 AOR ⩾41 week 0.88; 95% CI 0.1 to 10 compared with 40 to 40 6/7 week infants). These three variables provided the best prediction of a case (c=0.885, area under the receiver operating characteristic curve) and this prediction was significantly better than the use of the clinical risk factors, gestation and exclusive breastfeeding, alone (c=0.770, P<0.001) or the TcB percentile grouping alone (c=0.766, P<0.001). Substituting the TcB rate of rise (c=0.903, P=0.316) or the last measured TcB (c=0.873, P=0.292) for the maximum TcB measurement did not significantly improve the predictors of a case.

Conclusion:

Combining predischarge TcB levels with two clinical risk factors—gestational age and exclusive breastfeeding—significantly improves the prediction of subsequent hyperbilirubinemia.

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References

  1. American Academy of Pediatrics, Subcommittee on Hyperbilirubinemia. Clinical practice guideline: management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics 2004; 114: 297–316.

    Article  Google Scholar 

  2. Bhutani VK, Johnson L, Sivieri EM . Predictive ability of a predischarge hour-specific serum bilirubin for subsequent significant hyperbilirubinemia in healthy-term and near-term newborns. Pediatrics 1999; 103: 6–14.

    Article  CAS  Google Scholar 

  3. Alpay F, Sarici S, Tosuncuk HD, Serdar MA, Inanc N, Gokcay E . The value of first-day bilirubin measurement in predicting the development of significant hyperbilirubinemia in healthy term newborns. Pediatrics 2000; 106: E16.

    Article  CAS  Google Scholar 

  4. Carbonell X, Botet F, Figueras J, Riu-Godo A . Prediction of hyperbilirubinaemia in the healthy term newborn. Acta Paediatr 2001; 90: 166–170.

    Article  CAS  Google Scholar 

  5. Kaplan M, Hammerman C, Feldman R, Brisk R . Predischarge bilirubin screening in glucose-6-phosphate dehydrogenase-deficient neonates. Pediatrics 2000; 105: 533–537.

    Article  CAS  Google Scholar 

  6. Stevenson DK, Fanaroff AA, Maisels MJ, Young BWY, Wong RJ, Vreman HJ et al. Prediction of hyperbilirubinemia in near-term and term infants. Pediatrics 2001; 108: 31–39.

    Article  CAS  Google Scholar 

  7. Newman T, Liljestrand P, Escobar G . Combining clinical risk factors with bilirubin levels to predict hyperbilirubinemia in newborns. Arch Pediatr Adolesc Med 2005; 159: 113–119.

    Article  Google Scholar 

  8. Keren R, Luan X, Friedman S, Saddlemire S, Cnaan A, Bhutani V . A comparison of alternative risk-assessment strategies for predicting significant neonatal hyperbilirubinemia in term and near-term infants. Pediatrics 2008; 121: e170–e179.

    Article  Google Scholar 

  9. Maisels MJ, Kring E . Transcutaneous bilirubin levels in the first 96 hours in a normal newborn population of 35 or more weeks' of gestation. Pediatrics 2006; 117: 1169–1173.

    Article  Google Scholar 

  10. Newman TB, Browner WS, Cummings SR, Hulley SB . Designing an observational study; cross-sectional and case-controlled studies In: Hulley SB, Cummings SR, Browner, Browner WS, Grady D, Hearst N et al. (eds). Designing Clinical Research. 2nd edn. Williams and Wilkins: Philadelphia, PA, 2001, pp 107–123.

    Google Scholar 

  11. DeLong E, DeLong D, Clarke-Pearson D . Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 1988; 44: 837–845.

    Article  CAS  Google Scholar 

  12. Davidson LT, Merritt KK, Weech AA . Hyperbilirubinemia in the newborn. Am J Dis Child 1941; 61: 958–980.

    CAS  Google Scholar 

  13. Knudsen A . Prediction of the development of neonatal jaundice by increased umbilical cord blood bilirubin. Acta Pediatr Scand 1989; 78: 217–221.

    Article  CAS  Google Scholar 

  14. Saigal S, Lunyk O, Bennett KJ, Patterson MC . Serum bilirubin levels in breast- and formula-fed infants in the first 5 days of life. Can Med Assoc J 1982; 127: 985–989.

    CAS  PubMed  PubMed Central  Google Scholar 

  15. Bhutani V, Gourley GR, Adler S, Kreamer B, Dalman C, Johnson LH . Noninvasive measurement of total serum bilirubin in a multiracial predischarge newborn population to assess the risk of severe hyperbilirubinemia. Pediatrics 2000; 106: e17.

    Article  CAS  Google Scholar 

  16. Maisels MJ, Ostrea Jr E, Touch S, Clune S, Cepeda E, Kring E et al. Evaluation of a new transcutaneous bilirubinometer. Pediatrics 2004; 113: 1628–1635.

    Article  Google Scholar 

  17. Ebbesen F, Rasmussen LM, Wimberley PD . A new transcutaneous bilirubinometer, bilicheck, used in the neonatal intensive care unit and the maternity ward. Acta Paediatr 2002; 91: 203–211.

    Article  CAS  Google Scholar 

  18. Rubaltelli F, Gourley GR, Loskamp N, Modi N, Roth-Kleiner M, Sender A et al. Transcutaneous bilirubin measurement: a multicenter evaluation of a new device. Pediatrics 2001; 107: 1264–1271.

    Article  CAS  Google Scholar 

  19. Bhutani VK, Johnson LH, Schwoebel A, Gennaro S . A systems approach for neonatal hyperbilirubinemia in term and near-term newborns. J Obstet Gynecol Neonatal Nurs 2006; 35: 444–455.

    Article  Google Scholar 

  20. Maisels MJ, Kring EA . Length of stay, jaundice and hospital readmission. Pediatrics 1998; 101: 995–998.

    Article  CAS  Google Scholar 

  21. Maisels MJ, Kring E . Routine transcutaneous bilirubin (TcB) measurements in the nursery predict the risk of subsequent hyperbilirubinemia. E-PAS 2006; 59: 5575.479.

    Google Scholar 

  22. Eggert L, Wiedmeier SE, Wilson J, Christensen R . The effect of instituting a prehospital-discharge newborn bilirubin screening program in an 18-hospital health system. Pediatrics 2006; 117: e855–e862.

    Article  Google Scholar 

  23. Kuzniewicz MW, Escobar GJ, Newman TB . The impact of universal bilirubin screening on severe hyperbilirubinemia and phototherapy use in a managed care organization. Pediatrics 2009 (in press).

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Authors and Affiliations

  1. Department of Pediatrics and the Research Institute, William Beaumont Hospital, Royal Oak, MI, USA

    M J Maisels, J M DeRidder, E A Kring & M Balasubramaniam

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  1. M J Maisels
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  2. J M DeRidder
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  3. E A Kring
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  4. M Balasubramaniam
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Correspondence to M J Maisels.

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Maisels, M., DeRidder, J., Kring, E. et al. Routine transcutaneous bilirubin measurements combined with clinical risk factors improve the prediction of subsequent hyperbilirubinemia. J Perinatol 29, 612–617 (2009). https://doi.org/10.1038/jp.2009.43

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