title: Plotting transcutaneous bilirubin measurements on specific transcutaneous nomogram results in better prediction of significant hyperbilirubinemia in healthy term and near-term newborns: a pilot study.
abstract: BACKGROUND
  The American Academy of Pediatrics has recommended a systematic assessment before discharge for the risk of severe hyperbilirubinemia. Plotting total serum bilirubin (TSB) or transcutaneous bilirubin (TcB) on a TSB hour-specific nomogram is proposed as a tool for laboratory evaluation.
  
  
  OBJECTIVE
  The aim of this study was to compare the predictive characteristics, particularly the incidence of false negative rate (FNR), of the practice of plotting TcB values on the TSB hour-specific risk nomogram versus on transcutaneous nomogram.
  
  
  METHODS
  Paired TSB and TcB measurements were conducted on 141 newborns. Risk of developing significant hyperbilirubinemia was defined as infants with bilirubin level ≥ 75% on TSB or ≥ 95% on TcB nomogram. TSB values, plotted on the TSB nomogram of Bhutani et al. [Pediatrics 1999;103:6-14], were used as reference. TcB values were plotted on the TSB nomogram and on the transcutaneous nomograms of Maisels and Kring [Pediatrics 2006;117:1169-1173] and Fouzas et al. [Pediatrics 2010;125:e52-e57].
  
  
  RESULTS
  Plotting TcB measurements on a TSB nomogram resulted in a trend towards a higher FNR when compared to Maisels' and Fouzas' nomograms (18.0/1,000 compared to 10.2/1,000 and 8.6/1,000 respectively). Although not statistically significant, plotting TcB on transcutaneous nomogram resulted in better predictive values with the Fouzas' nomogram, having the best sensitivity (90.0%) and specificity (87.79%) as well as the highest positive (35.97%) and negative (99.14%) predictive value.
  
  
  CONCLUSIONS
  Plotting TcB on a TSB nomogram may result in increased rate of FNR and decreased predictive characteristics. The practice of plotting TcB on a TSB nomogram needs further evaluation.
authors.affiliation: Department of Pediatrics, CHU Sainte-Justine, University of Montreal, Montreal, Qué., Canada.
authors.forename: I
authors.initials: I
authors.lastname: Mohamed
authors.forename: A C
authors.initials: AC
authors.lastname: Blanchard
authors.forename: E
authors.initials: E
authors.lastname: Delvin
authors.forename: J
authors.initials: J
authors.lastname: Cousineau
authors.forename: A
authors.initials: A
authors.lastname: Carceller
mesh_terms: D000328:Adult; D001663:Bilirubin / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D003430:Cross-Sectional Studies; D005188:False Negative Reactions; D005260:Female; D005865:Gestational Age; D006801:Humans; D006932:Hyperbilirubinemia / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D007231:Infant, Newborn; D007234:Infant, Premature / Q000097:blood*; D008297:Male; D015997:Neonatal Screening / Q000379:methods*; D049451:Nomograms; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D047929:Term Birth / Q000097:blood*
chemical_list: D015415:Biomarkers; D001663:Bilirubin