title: Transcutaneous bilirubin levels in newborns <35 weeks' gestation.
abstract: OBJECTIVE
  In infants <35 weeks' gestation, we sought to define the transcutaneous bilirubin (TcB) levels at which a total serum bilirubin (TSB) level suggesting the need for phototherapy is unlikely to occur and a TSB measurement can, therefore, be avoided.
  
  
  METHODS
  Nursing staff performed 896 TcB measurements within 1 h of a TSB on 225 neonates 26 0/7-34 6/7 weeks' postmenstrual age (PMA). Generalized linear models were fit with generalized estimating equations (GEEs) to model the probability of having a TSB level at or above the phototherapy initiation cutpoint as a function of the TcB; these methods allow for multiple tests per infant.
  
  
  RESULTS
  The mean difference between TcB and TSB measurements was <1 mg dl(-1) for each PMA category. When the TcB was at least 3 mg dl(-1) below the TSB cutpoint for phototherapy, there was a ⩾98% probability that the TSB was not at, or above, the recommended phototherapy level. The single exception to this was a phototherapy level of 6 mg dl(-1) for infants of 28 0/7-29 6/7 weeks' PMA, where a TcB of 4 mg dl(-1) below the phototherapy level (ie a TcB ⩽2 mg dl(-1)) was necessary to achieve ⩾98% probability.
  
  
  CONCLUSIONS
  Our data support the use of routine TcB screening for infants 28-34 6/7 weeks' gestation. TcB screening in the neonatal intensive care unit can identify infants who require a TSB to confirm or exclude the need for phototherapy.
authors.affiliation: Department of Pediatrics, Oakland University William Beaumont School of Medicine, Beaumont Children's Hospital, Royal Oak, MI, USA.
authors.forename: M J
authors.initials: MJ
authors.lastname: Maisels
authors.affiliation: Department of Biostatistics, William Beaumont Hospital Research Institute, Royal Oak, MI, USA.
authors.forename: M P
authors.initials: MP
authors.lastname: Coffey
authors.affiliation: Department of Pediatrics, Oakland University William Beaumont School of Medicine, Beaumont Children's Hospital, Royal Oak, MI, USA.
authors.forename: E
authors.initials: E
authors.lastname: Kring
mesh_terms: D001663:Bilirubin / Q000097:blood*; D004867:Equipment Design; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature / Q000097:blood; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data; D007567:Jaundice, Neonatal / Q000097:blood / Q000175:diagnosis / Q000628:therapy; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods; D015997:Neonatal Screening / Q000295:instrumentation*; D009732:Nursing Care / Q000379:methods; D010789:Phototherapy / Q000379:methods*; D011237:Predictive Value of Tests; D012867:Skin / Q000378:metabolism
chemical_list: D001663:Bilirubin