Published online September 28, 2009
PEDIATRICS Vol. 124 No. 4 October 2009, pp. 1052-1059 (doi:10.1542/peds.2008-2322)

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ARTICLE

Transcutaneous Bilirubin Nomogram for Prediction of Significant Neonatal Hyperbilirubinemia

Anastasia Varvarigou, MD, Sotirios Fouzas, MD, Eleni Skylogianni, MD, Lito Mantagou, MD, Dorothea Bougioukou, MD and Stefanos Mantagos, MD

Department of Pediatrics, University Hospital of Patras, Patras, Greece

OBJECTIVE: The goal was to develop a predictive nomogram, based on transcutaneous bilirubin (TcB) measurements, for assessment of the risk of significant hyperbilirubinemia in healthy term and near-term neonates.

METHODS: A total of 10382 TcB measurements were performed with 2039 healthy neonates (gestational age of 35 weeks and birth weight of 2000 g), with a BiliCheck bilirubinometer (SpectRx, Norcross, GA), at designated time points between 12 and 120 hours of life. According to their severity, these TcB measurements were selectively cross-checked with a direct spectrophotometric device, and significant hyperbilirubinemia was defined on the basis of the hour-specific threshold values for phototherapy proposed by the American Academy of Pediatrics. With the use of likelihood ratios (LRs), the high- and low-risk demarcators for each designated time were calculated and presented on an hour-specific nomogram.

RESULTS: Significant hyperbilirubinemia was documented for 122 neonates (6%). At 24 hours of life, the high-risk zone of the nomogram had 73.9% sensitivity and a positive LR of 12.1 in predicting significant hyperbilirubinemia, whereas the low-risk zone had 97.7% sensitivity and a negative LR of 0.04. At 48 hours, the high-risk zone had 90% sensitivity and a positive LR of 12.1, whereas the low-risk zone had 98.8% sensitivity and a negative LR of 0.02. In our study population, the probability of significant hyperbilirubinemia would be >35% for values in the high-risk zone and <0.5% for values in the low-risk zone of the nomogram.

CONCLUSIONS: We provide a predictive TcB tool that could allow for a noninvasive, risk-based approach to neonatal hyperbilirubinemia.

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Key Words: hyperbilirubinemia • jaundice • neonates • predictive nomogram • transcutaneous bilirubin

Abbreviations: TSB—total serum bilirubin • TcB—transcutaneous bilirubin • AAP—American Academy of Pediatrics • LR—likelihood ratio • ROC—receiver operating characteristic

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Accepted Jan 30, 2009.

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