Petersen John R, Okorodudu Anthony O, Mohammad Amin A, Fernando Amarasiri, Shattuck Karen E
Departments of Pathology, University of Texas Medical Branch, Galveston, TX 77555-0551, USA.
Clin Chem. 2005 Mar;51(3):540-4. doi: 10.1373/clinchem.2004.037804.
Newborns are being discharged from hospitals within 1-2 days of birth, before hyperbilirubinemia usually becomes clinically evident. We investigated the use of transcutaneous bilirubin (TcB) before discharge to determine whether it affects the use of laboratory bilirubin testing or decreases the number of neonates readmitted for hyperbilirubinemia within 7 days of initial discharge.
We retrospectively searched a clinical laboratory and hospital database to determine the number of births, newborn readmission rates for hyperbilirubinemia, length of stay, and the number of bilirubin measurements in the clinical laboratory ordered for all babies in the newborn unit at the University of Texas Medical Branch from August 2002 to March 2003 (before TcB testing) and from May 2003 to December 2003 (after TcB).
Between August 2002 and December 2003, 8974 newborns (both vaginal and cesarean births) were admitted to the newborn nursery. Babies who did not fit the diagnosis-related group criteria of "normal newborn" were removed, leaving 6933 babies who were included in the study. April was considered a transition month and was not included in the study, leaving 6603 newborns to be included. Of these, 446 (6.8%) required phototherapy for treatment of hyperbilirubinemia before initial discharge. For the 8 months before and 8 months after initiation of TcB testing, the number of laboratory bilirubin measurements ordered per newborn did not change, nor did the mean (SD) length of stay for normal newborns [2.15 (1.1) days vs 2.12 (1.1) days; P = 0.53], nor days of treatment with phototherapy before discharge [2.9 (1.3) days vs 2.9 (1.3) days; P = 0.67]. By contrast, the number of readmissions per 1000 newborns per month for clinically significant hyperbilirubinemia decreased significantly (Wilcoxon rank-sums two-sample test, P = 0.044), from 4.5 (2.4) to 1.8 (1.7) after TcB testing was initiated.
Access to TcB testing is associated with a reduction in the hospital readmission rate for hyperbilirubinemia within 7 days of the initial discharge.
新生儿通常在出生后1 - 2天内出院，此时高胆红素血症在临床上通常尚未明显表现出来。我们研究了出院前经皮胆红素（TcB）的使用情况，以确定其是否会影响实验室胆红素检测的使用，或减少初次出院后7天内因高胆红素血症再次入院的新生儿数量。
我们回顾性检索了临床实验室和医院数据库，以确定德克萨斯大学医学分校新生儿病房2002年8月至2003年3月（在进行TcB检测之前）以及2003年5月至2003年12月（在进行TcB检测之后）所有婴儿的出生数量、高胆红素血症新生儿再入院率、住院时间以及临床实验室下达的胆红素测量次数。
2002年8月至2003年12月期间，8974名新生儿（包括顺产和剖宫产）入住新生儿重症监护室。不符合“正常新生儿”诊断相关组标准的婴儿被排除，留下6933名婴儿纳入研究。4月被视为过渡月，未纳入研究，最终纳入6603名新生儿。其中，446名（6.8%）在初次出院前因高胆红素血症需要接受光疗。在开始进行TcB检测前的8个月和之后的8个月，每个新生儿的实验室胆红素测量次数没有变化，正常新生儿的平均（标准差）住院时间也没有变化[2.15（1.1）天对2.12（1.1）天；P = 0.53]，出院前光疗治疗天数也没有变化[2.9（1.3）天对2.9（1.3）天；P = 0.67]。相比之下，每月每1000名新生儿因具有临床意义的高胆红素血症再次入院的人数显著减少（Wilcoxon秩和双样本检验，P = 〇〇44），从开始进行TcB检测前的4.5（2.4）降至1.8（1.7）。
进行TcB检测与初次出院后7天内高胆红素血症的医院再入院率降低有关。
