Ho H T, Ng T K, Tsui K C, Lo Y C
Department of Paediatrics and Adolescent Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China.
Arch Dis Child Fetal Neonatal Ed. 2006 Nov;91(6):F434-8. doi: 10.1136/adc.2005.090217. Epub 2006 Jul 18.
To evaluate the use of a new transcutaneous bilirubinometer (JM-103 Minolta Airshields) for detection of hyperbilirubinaemia in term or near-term healthy Chinese newborns.
Transcutaneous bilirubin (TcB) was used to screen for severe hyperbilirubinaemia in newborn infants. Blood was taken for total serum bilirubin (TSB) measurement if the initial TcB level was higher than the 40th centile in Bhutani's nomogram. Paired TcB and TSB results were then reviewed over 6 months. The correlation as well as the mean difference between the two methods were calculated. The clinical application of TcB with Bhutani's nomogram in the prediction of severe hyperbilirubinaemia in low-risk, medium-risk and high-risk thresholds for phototherapy was also analysed.
997 paired TcB and TSB measurements were evaluated in term or near-term newborns. TcB was significantly correlated with TSB, with a correlation coefficient of 0.83 (p<0.001). Their mean difference was 21.7 micromol/l (SD 21.2, p<0.001), with the 95% limits of agreement between -19.9 and 63.3 micromol/l. In both low-risk and medium-risk thresholds for phototherapy, using the 75th centile of Bhutani's nomogram as threshold, TcB could identify all cases and had a sensitivity and negative predictive value of 100% each, a specificity of 56% and positive predictive value of 23%. For high-risk cases, using the 75th centile as cut-off, the sensitivity and negative predictive value were reduced to 86.7% and 97.0%, respectively.
An accurate point-of-care bilirubin analyser facilitates bilirubin screening and avoids unnecessary blood tests. Although using the transcutaneous bilirubinometer JM-103 might result in a significant difference between TcB and TSB measured in Chinese newborns, combining the use of TcB and the 75th centile in Bhutani's nomogram as the cut-off level can identify all cases of significant hyperbilirubinaemia.
评估一种新型经皮胆红素仪（JM - 103美能达空气屏蔽型）用于检测足月儿或近足月儿健康中国新生儿高胆红素血症的效果。
采用经皮胆红素（TcB）筛查新生儿严重高胆红素血症。若初始TcB水平高于布塔尼列线图中的第40百分位数，则采集血样测定总血清胆红素（TSB）。随后对6个月内的TcB和TSB配对结果进行回顾分析。计算两种方法之间的相关性以及平均差异。还分析了将TcB与布塔尼列线图结合应用于预测低风险、中等风险和高风险光疗阈值下严重高胆红素血症的临床应用情况。
对997例足月儿或近足月儿的TcB和TSB配对测量结果进行了评估。TcB与TSB显著相关，相关系数为0.83（p<0.001）。它们的平均差异为21.7微摩尔/升（标准差21.2，p<0.001），95%一致性界限在 - 19.9至63.3微摩尔/升之间。在低风险和中等风险光疗阈值下，以布塔尼列线图的第75百分位数为阈值，TcB可识别所有病例，灵敏度和阴性预测值均为100%，特异性为56%，阳性预测值为23%。对于高风险病例，以第75百分位数为截断值，灵敏度和阴性预测值分别降至86.7%和97.0%。
一种准确的即时胆红素分析仪有助于胆红素筛查并避免不必要的血液检测。尽管使用经皮胆红素仪JM - 103可能导致中国新生儿测量的TcB和TSB之间存在显著差异，但将TcB与布塔尼列线图中的第75百分位数结合作为截断水平可识别所有显著高胆红素血症病例。
