title: Skin bilirubin nomogram for the first 96 h of life in a European normal healthy newborn population, obtained with multiwavelength transcutaneous bilirubinometry.
abstract: OBJECTIVE
  Hour-specific nomogram evaluation of serum or skin bilirubin is a suitable approach for managing neonatal hyperbilirubinemia and it is recommended by American Academy of Paediatrics. We aimed to provide data about skin bilirubin levels during the natural course of hyperbilirubinemia in European healthy neonates.
  
  
  METHODS
  We enrolled 2198 healthy newborn infants (gestational age [GA]>or= 35 weeks), from 24 to 96 h of life and performed transcutaneous bilirubin (TcB) measurement, in order to draw the nomogram for 10th, 25th, 50th, 75th and 95th percentiles of skin bilirubin, both for term and near term babies. All measurements were performed with a multiwavelength transcutaneous bilirubinometer (Respironics BiliCheck), within 2 h of the designed time and data were analysed with linear and local smoother regression.
  
  
  RESULTS
  We described the peculiar pattern of skin bilirubin increasing rate over different time periods. Bilirubin linearly increases rapidly in the first 48 h and less rapidly from 48 to 72 h, while the increment is insignificant from 72 to 96 h.
  
  
  CONCLUSIONS
  We provide the first data on skin bilirubin trend in a large predominantly breastfed and healthy European newborn population during the natural course of nonpathologic hyperbilirubinemia. Nomogram and increment rate of skin bilirubin are useful to identify neonates requiring closer evaluation and to plan an adequate follow-up.
authors.affiliation: Division of Neonatology, Department of Paediatrics, University Hospital A. Gemelli, Catholic University of the Sacred Heart, Rome, Italy. dm.deluca@fastwebnet.it
authors.forename: Daniele
authors.initials: D
authors.lastname: De Luca
authors.forename: Costantino
authors.initials: C
authors.lastname: Romagnoli
authors.forename: Eloisa
authors.initials: E
authors.lastname: Tiberi
authors.forename: Antonio Alberto
authors.initials: AA
authors.lastname: Zuppa
authors.forename: Enrico
authors.initials: E
authors.lastname: Zecca
mesh_terms: D001663:Bilirubin / Q000032:analysis*; D005060:Europe; D005260:Female; D006801:Humans; D051556:Hyperbilirubinemia, Neonatal / Q000175:diagnosis*; D007231:Infant, Newborn; D008297:Male; D015997:Neonatal Screening / Q000379:methods*; D012016:Reference Values; D012867:Skin / Q000737:chemistry*
chemical_list: D001663:Bilirubin