Advertising Disclaimer
Published online October 12, 2009
PEDIATRICS Vol. 124 No. 5 November 2009, pp. e851-e857 (doi:10.1542/peds.2008-3623)
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow View eLetters
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrowRequest Permissions
Citing Articles
Right arrow Citing Articles via CrossRef
Google Scholar
Right arrow Articles by Dalal, S. S.
Right arrow Articles by Paul, V.
PubMed
Right arrow PubMed Citation
Right arrow Articles by Dalal, S. S.
Right arrow Articles by Paul, V.
Related Collections
Right arrow Premature & Newborn
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Digg   Add to Facebook   Add to Reddit   Add to Technorati   Add to Twitter  
What's this?

ARTICLE

Does Measuring the Changes in TcB Value Offer Better Prediction of Hyperbilirubinemia in Healthy Neonates?

Shamsher Singh Dalal, MD, Satish Mishra, MD, DM, Ramesh Agarwal, MD, DM, Ashok Kumar Deorari, MD, Vinod Paul, MD, PhD

Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India

OBJECTIVE: We evaluated the diagnostic value of changes in transcutaneous bilirubin (TcB) levels for prediction of subsequent hyperbilirubinemia in healthy term and late-preterm neonates.

METHODS: Neonates at 35 weeks of gestation were enrolled in a prospective study. Two TcB determinations were performed for all enrolled neonates (N = 358). The first assessment (TcB1) was performed at 24 ± 6 hours of age, followed by a second (TcB2) ≥12 hours later. Changes in TcB levels were calculated. TcB values were plotted on an hour-specific serum bilirubin nomogram, and risk zones were recorded. Of the 358 neonates enrolled, 325 neonates (91%) were monitored for hyperbilirubinemia until 5 days of age.

RESULTS: The mean ages of TcB1 and TcB2 estimations were 23 ± 4 hours and 42 ± 4 hours, respectively. A total of 14.9% of neonates (48 of 325 neonates) developed hyperbilirubinemia by 5 days of age. The sensitivity, specificity, and positive and negative likelihood ratios for prediction of subsequent hyperbilirubinemia for TcB1 (zone >2, >75th percentile) were 80.4%, 58.0%, 1.9, and 0.34; those for TcB2 (zone >2, >75th percentile) were 82.6%, 79.0%, 4.0, and 0.22; and those for the change in TcB levels (>0.18 mg/dL per hour, >75th percentile) were 82.5%, 82.9%, 4.8, and 0.21, respectively. Gestational age, TcB risk zone, and change in TcB levels were found to be independent predictors of subsequent hyperbilirubinemia.

CONCLUSIONS: Single TcB measurements at 30 to 48 hours predict hyperbilirubinemia with a reasonably high degree of accuracy. Changes in TcB levels do not offer any added clinical benefit.

Key Words: neonates • transcutaneous bilirubinometry • change in transcutaneous bilirubin levels • hyperbilirubinemia

Abbreviations: AAP—American Academy of Pediatrics • AUC—area under the curve • ROC—receiver operating characteristic • STB—serum total bilirubin • TcB—transcutaneous bilirubin

Accepted Jun 4, 2009.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Facebook Facebook   Add to Reddit Reddit   Add to Technorati Technorati   Add to Twitter Twitter    What's this?


eLetters:

Read all eLetters

Prediction of Neonatal Hyperbilirubinemia
Michael Kaplan, et al.
Pediatrics Online, 23 Nov 2009 [Full text]