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Pediatrics. 2016 May;137(5). pii: e20153032. doi: 10.1542/peds.2015-3032. Epub 2016 Apr 6.

Utility of Decision Rules for Transcutaneous Bilirubin Measurements.

Author information

1
Department of Pediatrics, University of Washington, Seattle, Washington; uncjat@uw.edu.
2
Kaiser Permanente, Downey, California;
3
Department of Pediatrics, University of California San Francisco, San Francisco, California;
4
Department of Pediatrics, Sidney Kimmel Medical College of Thomas Jefferson University and Nemours, Philadelphia, Pennsylvania;
5
Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri;
6
Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio;
7
Holy Cross Health, Silver Spring, Maryland; and.
8
Academic Pediatric Association, McLean, Virginia.

Abstract

BACKGROUND:

Transcutaneous bilirubin (TcB) meters are widely used for screening newborns for jaundice, with a total serum bilirubin (TSB) measurement indicated when the TcB value is classified as "positive" by using a decision rule. The goal of our study was to assess the clinical utility of 3 recommended TcB screening decision rules.

METHODS:

Paired TcB/TSB measurements were collected at 34 newborn nursery sites. At 27 sites (sample 1), newborns were routinely screened with a TcB measurement. For sample 2, sites that typically screen with TSB levels also obtained a TcB measurement for the study. Three decision rules to define a positive TcB measurement were evaluated: ≥75th percentile on the Bhutani nomogram, 70% of the phototherapy level, and within 3 mg/dL of the phototherapy threshold. The primary outcome was a TSB level at/above the phototherapy threshold. The rate of false-negative TcB screens and percentage of blood draws avoided were calculated for each decision rule.

RESULTS:

For sample 1, data were analyzed on 911 paired TcB-TSB measurements from a total of 8316 TcB measurements. False-negative rates were <10% with all decision rules; none identified all 31 newborns with a TSB level at/above the phototherapy threshold. The percentage of blood draws avoided ranged from 79.4% to 90.7%. In sample 2, each rule correctly identified all 8 newborns with TSB levels at/above the phototherapy threshold.

CONCLUSIONS:

Although all of the decision rules can be used effectively to screen newborns for jaundice, each will "miss" some infants with a TSB level at/above the phototherapy threshold.

PMID:
27244792
PMCID:
PMC4845868
DOI:
10.1542/peds.2015-3032
[Indexed for MEDLINE]
Free PMC Article

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