Subject(s)
Peritonitis/diagnostic imaging , Fetal Diseases/diagnostic imaging , Humans , Infant, Newborn , Male , UltrasonographyABSTRACT
UNLABELLED: The aim is to establish the correlation between transcutaneous bilirubin (TCB) and serum bilirubin (TSB) and its predictive value for significant hyperbilirubinaemia > or = 290 mcmol/L (17 mg/dL). We studied a total of 2004 healthy full-term newborns, weight 3.230 g +/- 491 g; 90% received breast milk. The study was performed in two phases. In the first phase (610 newborns), the following tests were carried out: hematocrit and bilirubin in umbilical cord blood; TCB at 24 h, 48 h and between 60 h and 96 h at the forehead and over the sternum; TSB was measured along with this last test. In the second phase (1394 newborns), the predictive value of TCB and TSB was validated. The incidence of bilirubin > or = 290 mcmol/L was 2.95% and 3.2%. The correlation between TSB and TCB is high (n = 996; r = 0.92; y = 5.916 + 0.804x; p < 0.000). There was a better correlation between TCB and TSB with sternal compared to forehead determination (< 24 h: 0.81 vs 0.77; 24-48 h: 0.887 vs 0.83; and > 48 h: 0.94 vs 0.83). The study showed the scant sensitivity of umbilical cord blood bilirubin and good predictive value at 24 h of TSB > or = 102 mcmol/L (6 mg/dL) and at 48 h of TSB > or = 154 mcmol/L (9 mg/dL) and TCB > or = 13 (equivalent to 154 mcmol/L). CONCLUSION: There is a good correlation between TCB and TSB. In infants with TSB > or = 102 mcmol/L at 24 h or TSB > or = 154 mcmol/L or transcutaneous readings > or = 13 h at 48 h, a TSB test must be performed after 48 h of life.
Subject(s)
Health Status , Hyperbilirubinemia/diagnosis , Bilirubin/blood , Fetal Blood/chemistry , Humans , Hyperbilirubinemia/blood , Incidence , Infant, Newborn , Jaundice, Neonatal/diagnosis , Jaundice, Neonatal/epidemiology , Predictive Value of TestsABSTRACT
OBJECTIVE: Nowadays economical criteria lead to early maternal hospital discharge, even before 48 hours after labor, producing an increase in neonatal readmissions for hyperbilirubinemia. We tried to predict the healthy term newborns that may develop a significant hyperbilirubinemia (> or = 17 mg/dl in the first 4 days of life). METHODS: Bilirubin in umbilical cord blood, transcutaneous measurements of bilirubin at 24, 48 and between 60 and 96 hours of life and bilirubin in blood obtained from heel-sticks at 96 hours was analyzed in 610 newborns. Moreover, serum bilirubin was determined at the same time-points in 169 newborns submitted to blood extractions for different reasons. The transcutaneous bilirubinometer used was a Minolta/Air-Shields JM-102. RESULTS: A significant hyperbilirubinemia was present in 2.95% of the newborns. The correlation between serum and transcutaneous bilirubin was high (r = 0.92; p < 0.0001). Umbilical cord blood bilirubin with a cut-off point of 2.2 mg/dl was not an useful predictor of neonatal jaundice. At 24 and 48 hours of life serum bilirubin levels > or = 6 mg/dl and > or = 9 mg/dl, respectively, predicted a subsequent hyperbilirubinemia with a sensitivity of 100% at both time-points, specificity of 47.5% and 64.3%, positive predictive value of 7.3% and 16.4%, respectively, and a negative predictive value of 100% for both. Transcutaneous measurement at 48 hours with a cut-off point of 13 (equivalent to a bilirubinemia of 9 mg/dl) predicts hyperbilirubinemia with a sensitivity of 94.4%, specificity of 51.7%, positive predictive value of 6.0% and negative predictive value of 99.6%. CONCLUSIONS: If the newborn presents a bilirubinemia > or = 6 mg/dl at 24 hours and > or = 9 mg/dl or a transcutaneous measurement > or = 13 at 48 hours a new bilirubin measurement must be performed between 48 and 72 hours of life.
