Predictive Ability of Predischarge Transcutaneous Bilirubin Measurement for Subsequent Significant Hyperbilirubinemia

Roh, Eui Jung; Lim, Jae Woo; Cheon, Eun Jung; Ko, Og Kyoung

Abstract

PURPOSE: The practice of early discharge of healthy term and near-term newborns is growing worldwide. For this reason, early identification of newborn at risk for developing significant hyperbilirubinemia has become a public health issue. We therefore investigated prospectively 1) the pattern of bilirubin levels of healthy newborn by measuring transcutaneous bilirubin in the first postnatal week, 2) the predictive ability of a predischarge transcutaneous bilirubin measurement to screen for risk of subsequent significant hyperbilirubinemia in healthy newborn.
METHODS
The study population consisted of 218 healthy term and near-term babies in the newborn unit at the Konyang University hospital during from August 2004 to June 2005. Transcutaneous bilirubin (TcB) measurements on the midsternum were initially made at the 24 hours of life, repeated daily until discharge, each measurement was performed just at the 24 hours after the previous measurement. And a postdischarge TcB was measured on the 7th day of life. The accuracy of the predischarge TcB as a predictor of subsequent hyperbilirubinemia was determined.
RESULTS
The mean bilirubin level is 4.51+/-1.63 mg/dL on the 1st day of life (n=218), 6.71+/-1.92 mg/dL on the 2nd day of life (n=186), 8.04+/-2.05 mg/dL on the 3rd day of life (n=118), 8.60+/-2.33 mg/dL on the 4th day of life (n=88) and 8.60+/-2.79 mg/dL on the 5th day of life (n=41). A total of 16/218 (7.3%) had significant hyperbilirubinemia. Predischarge, 5.5% of the population (12/218) had TcB values in the high risk zone (> or =95 percentile) at the 24 hours of life; of these, 66.7% (8/12) developed significant hyperbilirubinemia. Predischarge, 38% of the population (83/218) was in the low risk zone (<40 percentile) and there was no measurable risk for significant hyperbilirubinemia.
CONCLUSION
By measuring noninvasive transcutaneous bilirubin at the 24 hours of life, we can predict which newborn is at high risk of significant hyperbilirubinemia.