MULTICENTER OBSERVATIONAL STUDY TO EVALUATE STRATEGIES TO IDENTIFY INFANTS AT

这个子项目是许多研究子项目中利用 资源由NIH/NCRR资助的中心拨款提供。子项目和 调查员(PI)可能从NIH的另一个来源获得了主要资金， 并因此可以在其他清晰的条目中表示。列出的机构是 该中心不一定是调查人员的机构。 在其他健康的新生儿中，有60%的新生儿有与血清总胆红素(TSB)浓度升高相关的临床黄疸。对于大多数良性的，但TSB水平极高的未经治疗的婴儿可能会发展为核黄斑，这是一种由于胆红素毒性而导致的神经系统破坏性疾病。TSB水平通常在出生后3至5天达到峰值，通常在常规出院后。出院前评估随后高胆红素血症的风险应有助于适当的后续和管理；然而，评估这一风险的最有效战略尚不清楚。美国儿科学会推荐的两种选择是对胆红素进行分析，以小时为单位表示风险区域和/或评估临床风险因素。这些策略单独使用或结合使用的相对准确性尚不清楚。这项前瞻性多中心队列研究在不同种族的美国人群中检验了下列假设：1)与单独使用临床风险因素相比，出院前(72小时年龄)的胆红素风险区域比单独使用临床风险因素更准确地预测严重高胆红素血症的风险；2)联合使用出院前胆红素风险区域和临床风险因素比单独使用任一种方法更准确地预测显著的高胆红素血症。我们将测量2000名健康新生儿在24+6小时、36-48小时(出院前)、3-5天、7-14天的系列胆红素水平(TSB和经皮胆红素)。已知的临床危险因素、出院前TSB/TCB水平和出院前TCB水平的增加的前瞻性识别将被用于制定随后严重高胆红素血症(以小时为单位的年龄的第95个百分位数)和需要光疗的结果的预测规则。确定随后高胆红素血症风险的最佳出院前评估将确保婴儿从出生医院更安全地过渡到家中，并可能预防核黄体肿大。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Sixty percent of otherwise healthy newborns have clinicaljaundice associated with increased concentration of total serum bilirubin (TSB). The outcome for the majority benign, but infants with untreated extremely high TSB levels can develop kernicterus, a neurologically devastating condition due to bilirubin toxicity. TSB levels typically peak at age 3 to 5 days, usually after routine hospital discharge. Assessment before discharge of the risk for subsequent hyperbilirubinemia should facilitate appropriate follow-up and management; however the most effective strategy to assess this risk is unknown. Two options recommended by the American Academy of Pediatrics are analysis of bilirubin expressed as a risk zone on an hour-specific monogram and/or assessment of clinical risk factors. The relative accuracy of these strategies used alone or in combination is not known. This prospective multicenter cohort study tests the following hypotheses in a large racially diverse US population: 1) the pre-discharge (<72 hr of age) bilirubin risk zone plotted on an hour-specific nomogram more accurately predicts the risk of severe hyperbilirubinemia than the use of clinical risk factors alone; and 2) the combined use of pre-discharge bilirubin risk zone and clinical risk factors more accurately predicts significant hyperbilirubinemia than using either method alone. We will measure serial bilirubin levels (TSB and transcutaneous, TcB) in 2000 healthy newborns at age 24+6 hours, 36 to 48 hours (pre-discharge), 3 to 5 days, and 7 to 14 days. Prospective identification of known clinical risk factors, pre-discharge TSB/TcB levels and the increment in TcB levels prior to discharge will be used to develop prediction rules for the outcome of subsequent severe hyperbilirubinemia (>95th percentile for age in hours) and need for phototherapy. Identifying the optimal pre-discharge assessment for risk of subsequent hyperbilirubinemia will ensure a safer transition from the infant's birth hospital to home and may prevent kernicterus.