Transcutaneous bilirubin nomogram for prediction of significant neonatal hyperbilirubinemia.
OBJECTIVE
The goal was to develop a predictive nomogram, based on transcutaneous bilirubin (TcB) measurements, for assessment of the risk of significant hyperbilirubinemia in healthy term and near-term neonates.


METHODS
A total of 10382 TcB measurements were performed with 2039 healthy neonates (gestational age of > or =35 weeks and birth weight of > or =2000 g), with a BiliCheck bilirubinometer (SpectRx, Norcross, GA), at designated time points between 12 and 120 hours of life. According to their severity, these TcB measurements were selectively cross-checked with a direct spectrophotometric device, and significant hyperbilirubinemia was defined on the basis of the hour-specific threshold values for phototherapy proposed by the American Academy of Pediatrics. With the use of likelihood ratios (LRs), the high- and low-risk demarcators for each designated time were calculated and presented on an hour-specific nomogram.


RESULTS
Significant hyperbilirubinemia was documented for 122 neonates (6%). At 24 hours of life, the high-risk zone of the nomogram had 73.9% sensitivity and a positive LR of 12.1 in predicting significant hyperbilirubinemia, whereas the low-risk zone had 97.7% sensitivity and a negative LR of 0.04. At 48 hours, the high-risk zone had 90% sensitivity and a positive LR of 12.1, whereas the low-risk zone had 98.8% sensitivity and a negative LR of 0.02. In our study population, the probability of significant hyperbilirubinemia would be >35% for values in the high-risk zone and <0.5% for values in the low-risk zone of the nomogram.


CONCLUSIONS
We provide a predictive TcB tool that could allow for a noninvasive, risk-based approach to neonatal hyperbilirubinemia.
Department of Pediatrics, University Hospital of Patras, Patras, Greece.
Anastasia
A
Varvarigou
Sotirios
S
Fouzas
Eleni
E
Skylogianni
Lito
L
Mantagou
Dorothea
D
Bougioukou
Stefanos
S
Mantagos
D001663:Bilirubin / Q000032:analysis*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006115:Greece; D006801:Humans; D051556:Hyperbilirubinemia, Neonatal / Q000175:diagnosis* / Q000517:prevention & control; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods*; D015997:Neonatal Screening / Q000379:methods*; D049451:Nomograms; D018743:Perinatal Care / Q000379:methods; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D012867:Skin / Q000378:metabolism; D013053:Spectrophotometry; D047929:Term Birth; D013997:Time Factors
D001663:Bilirubin