Taylor James A, Burgos Anthony E, Flaherman Valerie, Chung Esther K, Simpson Elizabeth A, Goyal Neera K, Von Kohorn Isabelle, Dhepyasuwan Niramol
Department of Pediatrics, University of Washington, Seattle, Washington;
Kaiser Permanente, Downey, California;
Pediatrics. 2016 May;137(5). doi: 10.1542/peds.2015-3032. Epub 2016 Apr 6.
Transcutaneous bilirubin (TcB) meters are widely used for screening newborns for jaundice, with a total serum bilirubin (TSB) measurement indicated when the TcB value is classified as "positive" by using a decision rule. The goal of our study was to assess the clinical utility of 3 recommended TcB screening decision rules.
Paired TcB/TSB measurements were collected at 34 newborn nursery sites. At 27 sites (sample 1), newborns were routinely screened with a TcB measurement. For sample 2, sites that typically screen with TSB levels also obtained a TcB measurement for the study. Three decision rules to define a positive TcB measurement were evaluated: ≥75th percentile on the Bhutani nomogram, 70% of the phototherapy level, and within 3 mg/dL of the phototherapy threshold. The primary outcome was a TSB level at/above the phototherapy threshold. The rate of false-negative TcB screens and percentage of blood draws avoided were calculated for each decision rule.
For sample 1, data were analyzed on 911 paired TcB-TSB measurements from a total of 8316 TcB measurements. False-negative rates were <10% with all decision rules; none identified all 31 newborns with a TSB level at/above the phototherapy threshold. The percentage of blood draws avoided ranged from 79.4% to 90.7%. In sample 2, each rule correctly identified all 8 newborns with TSB levels at/above the phototherapy threshold.
Although all of the decision rules can be used effectively to screen newborns for jaundice, each will "miss" some infants with a TSB level at/above the phototherapy threshold.
经皮胆红素（TcB）测定仪广泛用于新生儿黄疸筛查，当根据判定规则将TcB值判定为“阳性”时，需进行总血清胆红素（TSB）测定。我们研究的目的是评估3种推荐的TcB筛查判定规则的临床实用性。
在34个新生儿病房收集配对的TcB/TSB测量值。在27个地点（样本1），对新生儿常规进行TcB测量筛查。对于样本2，通常采用TSB水平进行筛查的地点也为该研究获取了TcB测量值。评估了3种用于定义TcB测量阳性的判定规则：在布塔尼列线图上处于第75百分位数及以上、光疗水平的70%、以及在光疗阈值±3mg/dL范围内。主要结局是TSB水平达到或高于光疗阈值。计算每种判定规则的TcB筛查假阴性率和避免采血的百分比。
对于样本1，对总共8316次TcB测量中的911对配对TcB-TSB测量值进行了分析。所有判定规则的假阴性率均<10%；没有一种规则能识别出所有31例TSB水平达到或高于光疗阈值的新生儿。避免采血的百分比在79.4%至90.7%之间。在样本2中，每种规则都正确识别出了所有8例TSB水平达到或高于光疗阈值的新生儿。
虽然所有判定规则都可有效用于新生儿黄疸筛查，但每种规则都会“遗漏”一些TSB水平达到或高于光疗阈值的婴儿。
