Predictive ability of a predischarge hour-specific serum bilirubin for subsequent significant hyperbilirubinemia in healthy term and near-term newborns
Predictive ability of a predischarge hour-specific serum bilirubin for subsequent significant hyperbilirubinemia in healthy term and near-term newborns
复制标题
DOI：
10.1542/peds.103.1.6
复制
发表时间：
1999-01-01
期刊：
影响因子：
8
通讯作者：
Sivieri, EM
中科院分区：
文献类型：
--
作者：
Bhutani, VK;Johnson, L;Sivieri, EM
目的：评价通用的出院前血清胆红素检测对Coombs阴性的健康足月儿和近足月儿在出生后第1周内发生显著高胆红素血症的预测能力。总血清胆红素（TSB）水平在常规代谢筛查时，在宾夕法尼亚州医院良好的婴儿托儿所（n = 13 003）照顾的所有足月和近足月新生儿。记录TSB测量时的出生后年龄（小时）。根据新生儿出院前和出院后特定时间的TSB值构建了第一周的基于胆红素的列线图（n = 2840;中位体重= 3230 g，中位胎龄39周），符合健康新生儿分类标准（不包括直接Coombs试验阳性或60小时前需要光疗的患者）并参加了医院监督的家庭或门诊随访计划。确定出院前TSB作为后续高胆红素血症程度预测指标的准确性。列线图中的研究患者具有种族多样性。近60%是母乳喂养。出院前，研究人群的6.1%在18至72小时，TSB值在高风险区（大于或等于第95百分位数）;其中，39.5%（68/172）仍在该区域（似然比[LR] = 14.08，灵敏度= 54%;特异性= 96.2%，概率= 39.5%）。出院前，32.1%的人群（912/2840）的TSB值处于中等风险区。在这些新生儿中有临床意义的少数（58/912或6.4%）中，出院后TSB移动到高风险区（该移动的LR：3.2从上-中风险区和0.48从下-中风险区）。61.8%（1756/2840）的新生儿出院前TSB处于低危区（
Objective, To assess the predictive ability of a universal predischarge serum bilirubin measurement to screen for risk of subsequent significant hyperbilirubinemia in the direct Coombs negative healthy term and near-term newborn during the first postnatal week.Methods. Total serum bilirubin (TSB) levels were obtained at the time of the routine metabolic screen in all term and near-term newborns cared for in the Pennsylvania Hospital Well Baby Nursery (n = 13 003). postnatal age (in hours) at the time of TSB measurement was recorded. A percentile-based bilirubin nomogram for the first week was constructed from hour-specific predischarge and postdischarge TSB values of newborns (n = 2840; median BW = 3230 g and median gestational age 39 weeks) who met classification criteria for healthy newborns (excluding those with a positive direct Coombs test or those requiring phototherapy before age 60 hours) and who were enrolled in a hospital supervised home or outpatient follow-up program. The accuracy of the predischarge TSB as a predictor of subsequent degree of hyperbilirubinemia was determined.Results. The study patients in the nomogram were racially diverse. Nearly 60% were breastfed. Predischarge, 6.1% of the study population (172/2840) had TSB values in the high-risk zone (greater than or equal to 95th percentile) at 18 to 72 hours; of these, 39.5% (68/172) remained in that zone (likelihood ratio [LR] = 14.08, sensitivity = 54%; specificity = 96.2%, probability = 39.5%). Predischarge, 32.1% of the population (912/2840) had TSB values in the intermediate-risk zone. In a clinically significant minority of these newborns (58/912 or 6.4%), the postdischarge TSB moved into the high-risk zone (LR of this move: 3.2 from the upper-intermediate zone and .48 from the lower; intermediate risk zone). The predischarge TSB in 61.8% of the newborns (1756/2840) was in the low-risk zone (