Department of Pediatrics, Government Medical College and Hospital, Chandigarh, India.
Indian J Pediatr. 2012 Feb;79(2):198-201. doi: 10.1007/s12098-011-0409-x. Epub 2011 May 4.
To evaluate combined ability of clinical risk factors and transcutaneous bilirubin (TcB) in predicting pathological hyperbilirubinemia (PHB) needing treatment during first week of life in healthy term and late preterm neonates.
This prospective cohort study included healthy neonates with gestation ≥35 wk and birth weight ≥2000 g. TcB was measured with a multi-wavelength transcutaneous bilirubinometer (Bilichek®) at 30 ± 12 h of postnatal age. Follow-up was conducted as per American Academy of Pediatrics guidelines. For diagnosis of PHB, TcB was measured at each follow-up visit. Serum bilirubin was measured if TcB was >15 mg/dL or within 2 mg/dL of phototherapy cut-off.
Among 462 neonates [birth weight (g; mean ± SD): 2711 ± 431, gestation (wk; median, IQR): 38 (37-39), male: 52%] enrolled in the study, 392 (84.9%) completed followup and PHB was observed in 65 (16.6%) neonates. Discriminant ability of risk model, including both clinical risk factors and TcB, was better than the risk models with clinical risk factors or TcB alone (c-statistic: 0.86 vs. 0.74 vs. 0.77). On logistic regression analysis risk factors found significant were TcB (OR: 1.65, 95% CI: 1.4-1.9), gestation at birth (OR: 0.6, 95% CI: 0.50-0.77) and primiparity (OR: 2.1, 95% CI: 1.1-3.9). A risk prediction score was developed with these three risk factors as ordinal/dichotomous variables. Negative and positive predictive values for score <8 and >12 were 97% and 46%, respectively.
Risk score consisting of TcB, gestation at birth and parity status was able to accurately predict pathological hyperbilirubinemia in derivation cohort of healthy term and late preterm north Indian neonates.
评估临床危险因素和经皮胆红素（TcB）联合预测健康足月和晚期早产儿生后第 1 周内需要治疗的病理性高胆红素血症（PHB）的能力。
本前瞻性队列研究纳入了胎龄≥35 周且出生体重≥2000g 的健康新生儿。在生后 30±12 小时，采用多波长经皮胆红素计（Bilichek®）测量 TcB。根据美国儿科学会的指南进行随访。对于 PHB 的诊断，在每次随访时测量 TcB。如果 TcB＞15mg/dL 或接近光疗截止值 2mg/dL，则测量血清胆红素。
本研究共纳入 462 例新生儿[出生体重（g；均值±标准差）：2711±431，胎龄（周；中位数，IQR）：38（37-39），男婴：52%]，其中 392 例（84.9%）完成了随访，65 例（16.6%）新生儿出现 PHB。包括临床危险因素和 TcB 的风险模型的判别能力优于仅包含临床危险因素或 TcB 的风险模型（c 统计量：0.86 比 0.74 比 0.77）。在 logistic 回归分析中，有意义的危险因素是 TcB（OR：1.65，95%CI：1.4-1.9）、出生时胎龄（OR：0.6，95%CI：0.50-0.77）和初产妇（OR：2.1，95%CI：1.1-3.9）。以这三个危险因素为有序/二分类变量，建立了风险预测评分。评分＜8 和＞12 的阴性和阳性预测值分别为 97%和 46%。
由 TcB、出生时胎龄和产次组成的风险评分能够准确预测印度北部健康足月和晚期早产儿的病理性高胆红素血症。
