Cincinnati Children's Hospital, Cincinnati, OH 45229, USA.
Eur J Pediatr. 2009 Dec;168(12):1461-6. doi: 10.1007/s00431-009-0950-z. Epub 2009 Mar 3.
Routine bilirubin screening prior to newborn hospital discharge, using an hour-specific bilirubin nomogram, has been advocated to assess risk for subsequent severe hyperbilirubinemia. However, the false-negative rate has never been adequately studied. Our objective was to determine false-negative results of pre-discharge bilirubin screening. After routine pre-discharge, bilirubin screening was in place for over 4 years, we performed a retrospective chart review to identify infants readmitted for total bilirubin levels > 17 mg/dl (>290.7 micromol/l). We documented each infant's pre-discharge bilirubin level, risk-zone assignment by nomogram, the presence or absence of risk factors for severe hyperbilirubinemia, co-morbidities upon readmission, treatment received, and ultimate disposition. Readmitted infants whose pre-discharge bilirubin was in the low-risk (<40th percentile) and low-intermediate (40-75th percentile) risk zones of the nomogram, were considered false-negatives. Of the 6,220 infants discharged from the newborn nursery during the 51-month study period, 28 (0.45%) were readmitted for treatment of serum bilirubin levels > 17 mg/dl (>290.7 micromol/l). All received phototherapy and none required exchange transfusion. Pre-discharge bilirubin values were <40th percentile (low-risk zone) in one infant (3.6%), and between 40-75th percentiles (low-intermediate risk zone) in twelve infants (43%). Risk factors for the development of severe hyperbilirubinemia were present in 27 (96%) readmitted infants. In conclusion, nearly half of readmitted infants had pre-discharge bilirubin values in zones considered at lower risk. The use of pre-discharge bilirubin screening alone to assign future risk for severe hyperbilirubinemia may provide false reassurance. Rigorous research is required to determine the test characteristics of pre-discharge bilirubin screening before widespread acceptance and implementation. Universal early post-discharge follow-up should remain the cornerstone of preventing severe hyperbilirubinemia.
在新生儿出院前，使用特定小时的胆红素列线图进行常规胆红素筛查，以评估随后发生严重高胆红素血症的风险。然而，假阴性率从未得到充分研究。我们的目的是确定出院前胆红素筛查的假阴性结果。在常规出院前胆红素筛查实施超过 4 年后，我们进行了回顾性图表审查，以确定因总胆红素水平>17mg/dl（>290.7μmol/l）而再次入院的婴儿。我们记录了每个婴儿出院前的胆红素水平、列线图的风险区分配、严重高胆红素血症的危险因素存在或不存在、再次入院时的合并症、接受的治疗和最终转归。出院前胆红素处于列线图低风险（<40 百分位）和低中风险（40-75 百分位）区的再次入院婴儿被认为是假阴性。在 51 个月的研究期间，从新生儿病房出院的 6220 名婴儿中，有 28 名（0.45%）因血清胆红素水平>17mg/dl（>290.7μmol/l）而再次入院接受治疗。所有婴儿均接受了光疗，无一例需要换血。1 名婴儿（3.6%）的出院前胆红素值<40 百分位（低风险区），12 名婴儿（43%）的胆红素值在 40-75 百分位（低中风险区）。27 名（96%）再次入院的婴儿存在发生严重高胆红素血症的危险因素。总之，近一半再次入院的婴儿出院前胆红素值处于较低风险区。单独使用出院前胆红素筛查来预测严重高胆红素血症的未来风险可能会产生错误的保证。在广泛接受和实施之前，需要进行严格的研究来确定出院前胆红素筛查的测试特征。普遍进行早期出院后随访仍然是预防严重高胆红素血症的基石。
