Zhangbin Yu1, Shuping Han1, Jinxia Wu2, Mingxia Li3, Huaiyan Wang4, Jimei Wang5, Jiebo Liu6, Xinnian Pan7, Jie Yang8, Chao Chen9. 1. Department of Pediatrics, Nanjing Maternity and Child Health Care Hospital of Nanjing Medical University, Nanjing, China. 2. Department of Neonatology, Inner Mongolia Maternal and Child Health Care Hospital, Huhehot, China. 3. Department of Neonatology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China. 4. Department of Neonatology, Changzhou Maternal and Child Health Care Hospital, Changzhou, China. 5. Department of Neonatology, Gynecology and Obstetrics Hospital, Fudan University, Shanghai, China. 6. Department of Pediatrics, The Fifth People's Hospital of Shenzhen, Shenzhen, China. 7. Department of Neonatology, Guangxi Maternal and Child Health Hospital, Nanning, China. 8. Department of Neonatology, Guangdong Maternal and Children's Hospital, Guangzhou Medical College, Guangzhou, China. 9. Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China. Electronic address: chen6010@163.com.
Abstract
OBJECTIVE: to prospectively validate a previously constructed transcutaneous bilirubin (TcB) nomogram for identifying severe hyperbilirubinemia in healthy Chinese term and late-preterm infants. METHODS: this was a multicenter study that included 9,174 healthy term and late-preterm infants in eight hospitals of China. TcB measurements were performed using a JM-103 bilirubinometer. TcB values were plotted on a previously developed TcB nomogram, to identify the predictive ability for subsequent significant hyperbilirubinemia. RESULTS: in the present study, 972 neonates (10.6%) developed significant hyperbilirubinemia. The 40(th) percentile of the nomogram could identify all neonates who were at risk of significant hyperbilirubinemia, but with a low positive predictive value (PPV) (18.9%). Of the 453 neonates above the 95(th) percentile, 275 subsequently developed significant hyperbilirubinemia, with a high PPV (60.7%), but with low sensitivity (28.3%). The 75(th) percentile was highly specific (81.9%) and moderately sensitive (79.8%). The area under the curve (AUC) for the TcB nomogram was 0.875. CONCLUSIONS: this study validated the previously developed TcB nomogram, which could be used to predict subsequent significant hyperbilirubinemia in healthy Chinese term and late-preterm infants. However, combining TcB nomogram and clinical risk factors could improve the predictive accuracy for severe hyperbilirubinemia, which was not assessed in the study. Further studies are necessary to confirm this combination.
OBJECTIVE: to prospectively validate a previously constructed transcutaneous bilirubin (TcB) nomogram for identifying severe hyperbilirubinemia in healthy Chinese term and late-preterm infants. METHODS: this was a multicenter study that included 9,174 healthy term and late-preterm infants in eight hospitals of China. TcB measurements were performed using a JM-103 bilirubinometer. TcB values were plotted on a previously developed TcB nomogram, to identify the predictive ability for subsequent significant hyperbilirubinemia. RESULTS: in the present study, 972 neonates (10.6%) developed significant hyperbilirubinemia. The 40(th) percentile of the nomogram could identify all neonates who were at risk of significant hyperbilirubinemia, but with a low positive predictive value (PPV) (18.9%). Of the 453 neonates above the 95(th) percentile, 275 subsequently developed significant hyperbilirubinemia, with a high PPV (60.7%), but with low sensitivity (28.3%). The 75(th) percentile was highly specific (81.9%) and moderately sensitive (79.8%). The area under the curve (AUC) for the TcB nomogram was 0.875. CONCLUSIONS: this study validated the previously developed TcB nomogram, which could be used to predict subsequent significant hyperbilirubinemia in healthy Chinese term and late-preterm infants. However, combining TcB nomogram and clinical risk factors could improve the predictive accuracy for severe hyperbilirubinemia, which was not assessed in the study. Further studies are necessary to confirm this combination.