title: Total serum bilirubin exceeding exchange transfusion thresholds in the setting of universal screening.
abstract: OBJECTIVE
  To describe the incidence and predictors of total serum bilirubin (TSB) levels that meet or exceed American Academy of Pediatrics (AAP) exchange transfusion (ET) thresholds in the setting of universal screening.
  
  
  METHODS
  We conducted a retrospective cohort analysis of electronic data on 18 089 newborns ≥35 weeks gestation born at Northern California Kaiser Permanente Medical Care Program hospitals implementing universal TSB screening in 2005 to 2007, with chart review for subjects with TSB levels reaching the AAP threshold for ET.
  
  
  RESULTS
  The outcome developed in 22 infants (0.12%); 14 (63.6%) were <38 weeks gestation. Only one infant received an ET; none of the infants had documented sequelae. The first TSB was at least high-intermediate risk on the AAP risk-nomogram for all 22 infants and high-risk for those ≥38 weeks, but was less than the phototherapy level in 15 infants (68%). Of these 15 infants, 2 failed phototherapy and 13 did not have a TSB repeated in <24 hours. However, re-testing all infants at high-intermediate risk or greater would have required 2166 additional bilirubin tests.
  
  
  CONCLUSIONS
  Screening was sensitive but not specific for predicting exchange threshold.
authors: Department of Pediatrics, University of California, San Francisco, CA, USA. FlahermanV@peds.ucsf.edu
authors: Valerie J
authors: VJ
authors: Flaherman
authors: Michael W
authors: MW
authors: Kuzniewicz
authors: Gabriel J
authors: GJ
authors: Escobar
authors: Thomas B
authors: TB
authors: Newman
mesh_terms: D001663:Bilirubin / Q000097:blood*; D002140:California; D015331:Cohort Studies; D016208:Databases, Factual; D005078:Exchange Transfusion, Whole Blood / Q000592:standards* / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D017408:Guidelines as Topic; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007567:Jaundice, Neonatal / Q000097:blood / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D015997:Neonatal Screening / Q000592:standards*; D011237:Predictive Value of Tests; D012015:Reference Standards; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome
chemical_list: D001663:Bilirubin