title: Transcutaneous bilirubin nomogram for predicting neonatal hyperbilirubinemia in healthy term and late-preterm Chinese infants.
abstract: Identifying infants that will develop significant hyperbilirubinemia with the risk of kernicterus, and planning appropriate follow-up strategies, is particularly challenging. In this study, 36,921 transcutaneous bilirubin (TcB) measurements were obtained from 6,035 healthy neonates (gestational age ≥ 35 weeks and birth weight ≥ 2,000 g) between January 1 and December 31, 2009. All measurements were performed with the JM-103 bilirubinometer at designated times between 0 and 168 postnatal hours. TcB percentiles were calculated and used to develop an hour-specific nomogram. The rate of increase in TcB was higher during the first 72 h of age, after which levels declined to a plateau by 72-108 h of age. We constructed a TcB nomogram by using the 40th, 75th, and 95th percentile values of TcB for every 12 h of the studied interval. The 75th percentile curve of the nomogram may be an ideal cutoff point for intensive follow-up of the neonate for hyperbilirubinemia as it carries very high sensitivity (78.7%) and negative predictive value (98.5%). The specificity (45.7%) and positive predictive value (15.5%) decreased to reach their lowest levels at the 40th percentile. Of the neonates in the high-risk zone, 167 (48.8%) infants had persistent subsequent hyperbilirubinemia post-discharge, compared with 292 (27.0%) infants in the high-intermediate-risk zone at discharge. One-hundred and seventeen (5.5%) infants in the low-intermediate-risk zone moved into the high-risk zone during follow-up. No newborn infants in the low-risk zone became high-risk during follow-up. We provide an hour-specific TcB nomogram to predict neonatal hyperbilirubinemia in healthy term and late-preterm Chinese infants.
authors.affiliation: Department of Pediatrics, Nanjing Maternal and Child Health Hospital, Nanjing Medical University, Nanjing, China. zhangbinyu@njmu.edu.cn
authors.forename: Zhang-Bin
authors.initials: ZB
authors.lastname: Yu
authors.forename: Xiao-Yue
authors.initials: XY
authors.lastname: Dong
authors.forename: Shu-Ping
authors.initials: SP
authors.lastname: Han
authors.forename: Yu-Lin
authors.initials: YL
authors.lastname: Chen
authors.forename: Yu-Fang
authors.initials: YF
authors.lastname: Qiu
authors.forename: Li
authors.initials: L
authors.lastname: Sha
authors.forename: Qing
authors.initials: Q
authors.lastname: Sun
authors.forename: Xi-Rong
authors.initials: XR
authors.lastname: Guo
mesh_terms: D001663:Bilirubin / Q000378:metabolism*; D001724:Birth Weight; D002681:China / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D005865:Gestational Age; D006801:Humans; D051556:Hyperbilirubinemia, Neonatal / Q000175:diagnosis* / Q000453:epidemiology / Q000378:metabolism; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature / Q000378:metabolism*; D008297:Male; D049451:Nomograms; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D012867:Skin / Q000378:metabolism*; D013997:Time Factors
chemical_list: D001663:Bilirubin
references.citation: J Am Board Fam Med. 2007 May-Jun;20(3):266-71
references.pmid: 17478659
references.citation: Arch Pediatr Adolesc Med. 2009 Nov;163(11):1054-9
references.pmid: 19884597
references.citation: Pediatrics. 2004 Jun;113(6):1628-35
references.pmid: 15173483
references.citation: Hong Kong Med J. 2006 Apr;12(2):99-102
references.pmid: 16603775
references.citation: J Perinatol. 2009 Sep;29(9):612-7
references.pmid: 19421200
references.citation: Pediatrics. 1999 Nov;104(5 Pt 2):1198-203
references.pmid: 10545573
references.citation: J Perinatol. 2009 Feb;29 Suppl 1:S25-45
references.pmid: 19177057
references.citation: J Paediatr Child Health. 2007 Apr;43(4):297-302
references.pmid: 17444833
references.citation: Indian J Pediatr. 2008 Feb;75(2):119-23
references.pmid: 18334790
references.citation: Pediatrics. 2006 Apr;117(4):1174-83
references.pmid: 16585313
references.citation: Acta Paediatr. 2009 Dec;98(12):1902-8
references.pmid: 19508300
references.citation: Pediatrics. 2010 Jan;125(1):e52-7
references.pmid: 20008429
references.citation: Pediatrics. 2009 Oct;124(4):1052-9
references.pmid: 19786443
references.citation: Pediatrics. 2009 Feb;123(2):524-32
references.pmid: 19171618
references.citation: J Obstet Gynecol Neonatal Nurs. 2006 Jul-Aug;35(4):444-55
references.pmid: 16881988
references.citation: Acta Paediatr. 2008 Feb;97(2):146-50
references.pmid: 18254903
references.citation: J Perinat Med. 2003;31(1):81-8
references.pmid: 12661149
references.citation: Pediatr Clin North Am. 2004 Aug;51(4):843-61, vii
references.pmid: 15275978
references.citation: J Med Assoc Thai. 2005 Sep;88(9):1187-93
references.pmid: 16536103
references.citation: Pediatrics. 2004 Jul;114(1):297-316
references.pmid: 15231951
references.citation: Pediatrics. 1999 Jan;103(1):6-14
references.pmid: 9917432
references.citation: Arch Dis Child Fetal Neonatal Ed. 2006 Nov;91(6):F434-8
references.pmid: 16849367
references.citation: Hong Kong Med J. 2008 Oct;14(5):356-60
references.pmid: 18840905
references.citation: Eur J Pediatr. 2009 Sep;168(9):1025-30
references.pmid: 19277705
references.citation: Zhonghua Er Ke Za Zhi. 2009 Jan;47(1):30-2
references.pmid: 19573378