Department of Pediatrics, National Cheng Kung University Hospital and College of Medicine, National Cheng Kung University, Tainan, Taiwan; Jin-Sin Women and Children's Hospital, Tainan, Taiwan.
Department of Pediatrics, National Cheng Kung University Hospital and College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Pediatr Neonatol. 2019 Jun;60(3):291-296. doi: 10.1016/j.pedneo.2018.07.013. Epub 2018 Aug 2.
Hour-specific bilirubin nomogram has been recommended to predict postdischarge hyperbilirubinemia in newborns. However, it may not be applicable in Taiwan due to ethnic differences. The aim of this study was to construct a 12-h specific transcutaneous bilirubin (TCB) nomogram in newborns for clinical reference.
We prospectively enrolled full term or late preterm neonates born in a tertiary care hospital between October 2013 and July 2014. The exclusion criteria included chromosome anomaly, glucose-6-phosphate dehydrogenase deficiency, and receiving phototherapy within 60 h after birth. TCB measurements were performed by a single technician using the Bilichek device, and measured every 12 h until neonates were discharged. Patient data including sex, delivery mode, gestational age, body weight with daily change, and feeding pattern were collected for analysis. A TCB nomogram was constructed with 40th, 75th, and 95th percentile lines.
A total of 498 newborns were enrolled, and the characteristics between the hyperbilirubinemia and nonhyperbilirubinemia groups were not different. The mean TCB curve revealed that the peak TCB level was 14.2 ± 2.9 mg/dL at 100.6 ± 3.6 h of age. The peak 95th percentile TCB level was 19.4 mg/dL at 121.9 ± 5 h of age. Mean TCB levels increased at a rate of 0.01-0.21 mg/dL/h initially, followed by a decrease after 96-108 h of age. Twenty newborns (4%) were diagnosed with hyperbilirubinemia. Regarding TCB distribution, 11 of 60 (18%) had peak TCB levels above the 95th percentile, 5 of 151 (3%) had TCB levels between the 75th and 95th percentile, 4 of 200 (2%) had levels between the 40th and 75th percentiles, and none had a level below the 40th percentile.
A 12-h specific TCB nomogram could be a useful reference for workup for hyperbilirubinemia, particularly when it is above the 95th percentile line.
小时特异性胆红素列线图已被推荐用于预测新生儿出院后高胆红素血症。然而，由于种族差异，它可能不适用于中国台湾。本研究的目的是构建适用于新生儿的 12 小时特定经皮胆红素（TCB）列线图供临床参考。
我们前瞻性纳入 2013 年 10 月至 2014 年 7 月在一家三级保健医院出生的足月或晚期早产儿。排除标准包括染色体异常、葡萄糖-6-磷酸脱氢酶缺乏症和出生后 60 小时内接受光疗。TCB 测量由一名技术员使用 Bilichek 设备进行，每 12 小时测量一次，直到新生儿出院。收集患者数据，包括性别、分娩方式、胎龄、体重日变化和喂养模式进行分析。构建 TCB 列线图，包括第 40、75 和 95 个百分位数线。
共纳入 498 名新生儿，高胆红素血症组和非高胆红素血症组的特征无差异。平均 TCB 曲线显示，TCB 水平峰值为 14.2±2.9mg/dL，出现在 100.6±3.6 小时的年龄。第 95 个百分位数 TCB 水平峰值为 19.4mg/dL，出现在 121.9±5 小时的年龄。平均 TCB 水平最初以 0.01-0.21mg/dL/h 的速度增加，随后在 96-108 小时后下降。20 名新生儿（4%）被诊断为高胆红素血症。关于 TCB 分布，60 名中有 11 名（18%）的峰值 TCB 水平高于第 95 个百分位数，151 名中有 5 名（3%）的 TCB 水平在第 75-95 个百分位数之间，200 名中有 4 名（2%）的 TCB 水平在第 40-75 个百分位数之间，没有低于第 40 个百分位数的。
12 小时特定 TCB 列线图可作为高胆红素血症筛查的有用参考，特别是当超过第 95 个百分位数线时。
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