Olusanya Bolajoko O, Slusher Tina M, Imosemi Donald O, Emokpae Abieyuwa A
Center for Healthy Start Initiative, Lagos, Nigeria.
Department of Pediatrics, Division of Global Health, University of Minnesota, Minneapolis, Minnesota, United States of America.
PLoS One. 2017 Aug 24;12(8):e0183882. doi: 10.1371/journal.pone.0183882. eCollection 2017.
Mothers are frequently the first to observe the onset of jaundice in their newborn infants before the decision to seek treatment. However, simple-to-use tools that could facilitate early detection of jaundice and assist mothers to seek professional care, especially after hospital discharge, are rare. This study therefore, set out to evaluate the performance of a -two-color icterometer (Bilistrip™) as a possible screening tool for detecting significant jaundice by mothers or care-givers in the first week of life.
Prior to discharge, mothers in a maternity hospital were trained to use the Bilistrip™ on the blanched skin of their baby's nose to ascertain absence (Light Yellow) or presence (Dark Yellow) of significant jaundice. Their babies had transcutaneous bilirubin (TcB) measurements independently, along with total serum bilirubin (TSB) if indicated. The reliability of Bilistrip™ as a screening test for significant jaundice was determined at different TcB and TSB thresholds. The predictive performance of Bilistrip™ was also evaluated with multivariable logistic regression.
Some 2492 mother-infant pairs were enrolled over 15 months, of which 347 (13.9%) chose Dark Yellow. The mean TcB for Dark Yellow (10mg/dL) was significantly higher (p<0.001) than for Light Yellow (6.1mg/dL). Bilistrip™ showed increasing sensitivity (47.0% - 92.6%) and negative predictive value (NPV) (91.4% - 99.9%) for selected TcB thresholds (≥10mg/dL, ≥12mg/dL, ≥15mg/dL, and ≥17mg/dL). Among neonates with TSB measurements (n = 124), Bilistrip™ was associated also with increasing sensitivity (86.8% - 100%) and NPV (62.5% - 100%). The sensitivity and NPV for detecting neonates requiring phototherapy were 95.8% respectively. Only one of the 24 neonates who required phototherapy was missed by the Bilistrip™.
Bilistrip™ is a potential decision-making tool for empowering mothers to detect neonates with clinically significant jaundice that may require close monitoring or treatment, and neonates not requiring treatment for jaundice in the first week of life.
在决定寻求治疗之前，母亲往往是最先观察到新生儿黄疸发作的人。然而，简便易用的、能够促进黄疸早期检测并帮助母亲寻求专业护理的工具，尤其是在出院后，却很少见。因此，本研究旨在评估一种双色黄疸仪（Bilistrip™）作为母亲或护理人员在新生儿出生后第一周检测显著黄疸的可能筛查工具的性能。
在出院前，一家妇产医院的母亲们接受了使用Bilistrip™在其婴儿鼻子变白的皮肤上进行检测的培训，以确定是否存在（深黄色）或不存在（浅黄色）显著黄疸。她们的婴儿独立进行经皮胆红素（TcB）测量，如有需要还进行总血清胆红素（TSB）测量。在不同的TcB和TSB阈值下，确定Bilistrip™作为显著黄疸筛查试验的可靠性。还通过多变量逻辑回归评估了Bilistrip™的预测性能。
在15个月内共纳入了约2492对母婴，其中347对（13.9%）选择了深黄色。深黄色组的平均TcB（10mg/dL）显著高于浅黄色组（6.1mg/dL）（p<0.001）。对于选定的TcB阈值（≥10mg/dL、≥12mg/dL、≥15mg/dL和≥17mg/dL），Bilistrip™的敏感性（47.0% - 92.6%）和阴性预测值（NPV）（91.4% - 99.9%）均有所增加。在进行TSB测量的新生儿（n = 124）中，Bilistrip™的敏感性（86.8% - 100%）和NPV（62.5% - 100%）也有所增加。检测需要光疗的新生儿的敏感性和NPV分别为95.8%。在24例需要光疗的新生儿中，Bilistrip™仅漏诊了1例。
Bilistrip™是一种潜在的决策工具，可使母亲能够检测出可能需要密切监测或治疗的具有临床显著黄疸的新生儿，以及在出生后第一周不需要治疗黄疸的新生儿。
