Download PDF
Am J Perinatol 2015; 32(10): 944-951
DOI: 10.1055/s-0035-1544190
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Evaluation of Early Transcutaneous Bilirubinometry to Predict Subsequent Hyperbilirubinemia in Neonates Admitted to a Well-Baby Nursery

Gregory L. Jackson
1   Department of Pediatrics, The University of Texas Southwestern Medical Center, Dallas, Texas
,
Meghan Saumur
2   Office of Medical Education, The University of Texas Southwestern Medical Center, Dallas, Texas
*   Supported in part by the UT Southwestern Summer Medical Student Research Program
,
Vinita Chandwani
2   Office of Medical Education, The University of Texas Southwestern Medical Center, Dallas, Texas
*   Supported in part by the UT Southwestern Summer Medical Student Research Program
,
William D. Engle
1   Department of Pediatrics, The University of Texas Southwestern Medical Center, Dallas, Texas
› Author Affiliations
Further Information

Publication History

25 March 2014

12 December 2014

Publication Date:
04 March 2015 (online)

Also available at
    Permissions and Reprints

Abstract

Objective The aim of this study is to determine whether a transcutaneous bilirubin (TcB) value obtained within 6 hours of birth (early transcutaneous bilirubin [ETcB]) either alone, or used to calculate an early rate of rise (E-ROR) in TcB, will identify those neonates who are at a higher risk for subsequent jaundice.

Study Design ETcB values were obtained from a convenience sample of neonates admitted to the newborn nursery. E-ROR was calculated as the average hourly increase between ETcB and subsequent TcB obtained at 18 to 36 hours of age. TcB percentile values at various ages were obtained from a previously published and cross-validated nomogram. The predictive values relating ETcB, E-ROR, and TcB at 18 to 36 hours of age to TcB at 42 to 66 hours of age were determined, and receiver-operator characteristic curves were compared.

Results A total of 516 late preterm and term neonates were studied. ETcB was higher (p = 0.003) in those neonates who subsequently received phototherapy (n = 15), and negative predictive value was always ≥ 0.96; positive predictive value (PPV) ranged from 0.04 to 0.06. Compared with ETcB, TcB at 18 to 36 hours was more likely to predict significant jaundice at 42 to 66 hours of age.

Conclusion Given the observed low PPV, ETcB is not useful in identifying infants who develop subsequent hyperbilirubinemia. However, it may be helpful in identifying those neonates at a low risk of subsequent hyperbilirubinemia.

Keywords

jaundice - neonate - transcutaneous bilirubinometry - hyperbilirubinemia
 

  • References

  • 1 Maisels MJ, Kring E. Length of stay, jaundice, and hospital readmission. Pediatrics 1998; 101 (6) 995-998
    CrossrefPubMedGoogle Scholar
  • 2 Bhutani VK, Stark AR, Lazzeroni LC , et al; Initial Clinical Testing Evaluation and Risk Assessment for Universal Screening for Hyperbilirubinemia Study Group. Predischarge screening for severe neonatal hyperbilirubinemia identifies infants who need phototherapy. J Pediatr 2013; 162 (3) 477-482.e1
    CrossrefPubMedGoogle Scholar
  • 3 DeLuca D, Engle WD. Devices for non-invasive measurement of bilirubin. In: deLuca D, Engle WD, Jackson GL, , eds. Transcutaneous Bilirubinometry. New York: Nova Science Publishers, Inc.; 2013: 19-36
    Google Scholar
  • 4 Maisels MJ. Historical perspectives: Transcutaneous bilirubinometry. NeoReviews. 2006; 7: e217-e225
    CrossrefPubMedGoogle Scholar
  • 5 Wickremasinghe AC, Karon BS, Saenger AK, Cook WJ. Effect of universal neonatal transcutaneous bilirubin screening on blood draws for bilirubin analysis and phototherapy usage. J Perinatol 2012; 32 (11) 851-855
    CrossrefPubMedGoogle Scholar
  • 6 Wainer S, Parmar SM, Allegro D, Rabi Y, Lyon ME. Impact of a transcutaneous bilirubinometry program on resource utilization and severe hyperbilirubinemia. Pediatrics 2012; 129 (1) 77-86
    CrossrefPubMedGoogle Scholar
  • 7 Maisels MJ, Deridder JM, Kring EA, Balasubramaniam M. Routine transcutaneous bilirubin measurements combined with clinical risk factors improve the prediction of subsequent hyperbilirubinemia. J Perinatol 2009; 29 (9) 612-617
    CrossrefPubMedGoogle Scholar
  • 8 Kaplan M, Wong RJ, Sibley E, Stevenson DK. Neonatal jaundice and liver disease. In: Martin RJ, Fanaroff AA, Walsh MC, , eds. Neonatal-Perinatal Medicine: Diseases of the Fetus and Infant. St. Louis: Elsevier Publishing Co.; 2011: 1443-1496
    Google Scholar
  • 9 De Luca D, Jackson GL, Tridente A, Carnielli VP, Engle WD. Transcutaneous bilirubin nomograms: a systematic review of population differences and analysis of bilirubin kinetics. Arch Pediatr Adolesc Med 2009; 163 (11) 1054-1059
    PubMedGoogle Scholar
  • 10 De Luca D, Romagnoli C, Tiberi E, Zuppa AA, Zecca E. Skin bilirubin nomogram for the first 96 h of life in a European normal healthy newborn population, obtained with multiwavelength transcutaneous bilirubinometry. Acta Paediatr 2008; 97 (2) 146-150
    CrossrefPubMedGoogle Scholar
  • 11 Engle WD, Lai S, Ahmad N, Manning MD, Jackson GL. An hour-specific nomogram for transcutaneous bilirubin values in term and late preterm Hispanic neonates. Am J Perinatol 2009; 26 (6) 425-430
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 Maisels MJ, Kring E. Transcutaneous bilirubin levels in the first 96 hours in a normal newborn population of > or = 35 weeks' gestation. Pediatrics 2006; 117 (4) 1169-1173
    CrossrefPubMedGoogle Scholar
  • 13 Sanpavat S, Nuchprayoon I, Smathakanee C, Hansuebsai R. Nomogram for prediction of the risk of neonatal hyperbilirubinemia, using transcutaneous bilirubin. J Med Assoc Thai 2005; 88 (9) 1187-1193
    PubMedGoogle Scholar
  • 14 American Academy of Pediatrics Subcommittee on Hyperbilirubinemia. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics 2004; 114 (1) 297-316
    CrossrefPubMedGoogle Scholar
  • 15 Engle NG. Validation of a transcutaneous bilirubin (TcB) nomogram in identifying Hispanic neonates at risk for hyperbilirubinemia. Doctoral dissertation 2013. Retrieved from ProQuest UMI. (3610516)
    PubMedGoogle Scholar
  • 16 Bhutani VK, Johnson L, Sivieri EM. Predictive ability of a predischarge hour-specific serum bilirubin for subsequent significant hyperbilirubinemia in healthy term and near-term newborns. Pediatrics 1999; 103 (1) 6-14
    CrossrefPubMedGoogle Scholar
  • 17 Bental YA, Shiff Y, Dorsht N, Litig E, Tuval L, Mimouni FB. Bhutani-based nomograms for the prediction of significant hyperbilirubinaemia using transcutaneous measurements of bilirubin. Acta Paediatr 2009; 98 (12) 1902-1908
    CrossrefPubMedGoogle Scholar
  • 18 Draque CM, Sañudo A, de Araujo Peres C, de Almeida MFB. Transcutaneous bilirubin in exclusively breastfed healthy term newborns up to 12 days of life. Pediatrics 2011; 128 (3) e565-e571
    CrossrefPubMedGoogle Scholar
  • 19 Fouzas S, Karatza AA, Skylogianni E, Mantagou L, Varvarigou A. Transcutaneous bilirubin levels in late preterm neonates. J Pediatr 2010; 157 (5) 762-6.e1
    CrossrefPubMedGoogle Scholar
  • 20 Fouzas S, Mantagou L, Skylogianni E, Mantagos S, Varvarigou A. Transcutaneous bilirubin levels for the first 120 postnatal hours in healthy neonates. Pediatrics 2010; 125 (1) e52-e57
    CrossrefPubMedGoogle Scholar
  • 21 Mishra S, Chawla D, Agarwal R, Deorari AK, Paul VK. Transcutaneous bilirubin levels in healthy term and late preterm Indian neonates. Indian J Pediatr 2010; 77 (1) 45-50
    CrossrefPubMedGoogle Scholar
  • 22 Varvarigou A, Fouzas S, Skylogianni E, Mantagou L, Bougioukou D, Mantagos S. Transcutaneous bilirubin nomogram for prediction of significant neonatal hyperbilirubinemia. Pediatrics 2009; 124 (4) 1052-1059
    CrossrefPubMedGoogle Scholar
  • 23 Yu ZB, Dong XY, Han SP , et al. Transcutaneous bilirubin nomogram for predicting neonatal hyperbilirubinemia in healthy term and late-preterm Chinese infants. Eur J Pediatr 2011; 170 (2) 185-191
    CrossrefPubMedGoogle Scholar
  • 24 Keren R, Luan X, Friedman S, Saddlemire S, Cnaan A, Bhutani VK. A comparison of alternative risk-assessment strategies for predicting significant neonatal hyperbilirubinemia in term and near-term infants. Pediatrics 2008; 121 (1) e170-e179
    CrossrefPubMedGoogle Scholar
  • 25 Knudsen A, Brodersen R. Skin colour and bilirubin in neonates. Arch Dis Child 1989; 64 (4) 605-609
    CrossrefPubMedGoogle Scholar
  • 26 Brodersen R. Bilirubin. Solubility and interaction with albumin and phospholipid. J Biol Chem 1979; 254 (7) 2364-2369
    PubMedGoogle Scholar
  • 27 Knudsen A. The cephalocaudal progression of jaundice in newborns in relation to the transfer of bilirubin from plasma to skin. Early Hum Dev 1990; 22 (1) 23-28
    Google Scholar
  • 28 Maisels MJ, Kring E. The contribution of hemolysis to early jaundice in normal newborns. Pediatrics 2006; 118 (1) 276-279
    CrossrefPubMedGoogle Scholar
  • 29 Christensen RD, Yaish HM, Nussenzveig RH , et al. Acute kernicterus in a neonate with O/B blood group incompatibility and a mutation in SLC4A1. Pediatrics 2013; 132 (2) e531-e534
    CrossrefPubMedGoogle Scholar
  • 30 Knüpfer M, Pulzer F, Gebauer C, Robel-Tillig E, Vogtmann C. Predictive value of umbilical cord blood bilirubin for postnatal hyperbilirubinaemia. Acta Paediatr 2005; 94 (5) 581-587
    CrossrefPubMedGoogle Scholar
  • 31 Knudsen A. Prediction of the development of neonatal jaundice by increased umbilical cord blood bilirubin. Acta Paediatr Scand 1989; 78 (2) 217-221
    CrossrefPubMedGoogle Scholar
  • 32 Bernaldo AJN, Segre CAM. Bilirubin dosage in cord blood: could it predict neonatal hyperbilirubinemia?. Sao Paulo Med J 2004; 122 (3) 99-103
    CrossrefPubMedGoogle Scholar
  • 33 Jacobson MP, Bernstein HH. Limited diagnostic value of routine cord blood bilirubin determinations. Clin Pediatr (Phila) 1982; 21 (10) 610-612
    CrossrefPubMedGoogle Scholar
  • 34 Risemberg HM, Mazzi E, MacDonald MG, Peralta M, Heldrich F. Correlation of cord bilirubin levels with hyperbilirubinaemia in ABO incompatibility. Arch Dis Child 1977; 52 (3) 219-222
    CrossrefPubMedGoogle Scholar
  • 35 Sarici SÜ, Yurdakök M, Serdar MA , et al. An early (sixth-hour) serum bilirubin measurement is useful in predicting the development of significant hyperbilirubinemia and severe ABO hemolytic disease in a selective high-risk population of newborns with ABO incompatibility. Pediatrics 2002; 109 (4) e53
    CrossrefPubMedGoogle Scholar
  • 36 Parshuram CS, Hutchison J, Middaugh K. Development and initial validation of the Bedside Paediatric Early Warning System score. Crit Care 2009; 13 (4) R135
    CrossrefPubMedGoogle Scholar
  • 37 Whittington J, White R, Haig KM, Slock M. Using an automated risk assessment report to identify patients at risk for clinical deterioration. Jt Comm J Qual Patient Saf 2007; 33 (9) 569-574
    PubMedGoogle Scholar
  • 38 Maupin JM, Roth DJ, Krapes JM. Use of the Modified Early Warning Score decreases code blue events. Jt Comm J Qual Patient Saf 2009; 35 (12) 598-603
    PubMedGoogle Scholar