James A Taylor1, Anthony E Burgos2, Valerie Flaherman3, Esther K Chung4, Elizabeth A Simpson5, Neera K Goyal6, Isabelle Von Kohorn7, Niramol Dhepyasuwan8. 1. Department of Pediatrics, University of Washington, Seattle, Washington; uncjat@uw.edu. 2. Kaiser Permanente, Downey, California; 3. Department of Pediatrics, University of California San Francisco, San Francisco, California; 4. Department of Pediatrics, Sidney Kimmel Medical College of Thomas Jefferson University and Nemours, Philadelphia, Pennsylvania; 5. Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri; 6. Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio; 7. Holy Cross Health, Silver Spring, Maryland; and. 8. Academic Pediatric Association, McLean, Virginia.
Abstract
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
Authors: James A Taylor; Anthony E Burgos; Valerie Flaherman; Esther K Chung; Elizabeth A Simpson; Neera K Goyal; Isabelle Von Kohorn; Nui Dhepyasuwan Journal: Pediatrics Date: 2015-01-19 Impact factor: 7.124
Authors: Vinod K Bhutani; Ann R Stark; Laura C Lazzeroni; Ronald Poland; Glenn R Gourley; Steve Kazmierczak; Linda Meloy; Anthony E Burgos; Judith Y Hall; David K Stevenson Journal: J Pediatr Date: 2012-10-05 Impact factor: 4.406
Authors: William D Engle; Gregory L Jackson; Dorothy Sendelbach; Denise Manning; William H Frawley Journal: Pediatrics Date: 2002-07 Impact factor: 7.124
Authors: Tina M Slusher; Ishaya A Angyo; Fidela Bode-Thomas; Francis Akor; Sunday D Pam; Adedotun A Adetunji; Donald W McLaren; Ronald J Wong; Hendrik J Vreman; David K Stevenson Journal: Pediatrics Date: 2004-06 Impact factor: 7.124
Authors: James A Taylor; James W Stout; Lilian de Greef; Mayank Goel; Shwetak Patel; Esther K Chung; Aruna Koduri; Shawn McMahon; Jane Dickerson; Elizabeth A Simpson; Eric C Larson Journal: Pediatrics Date: 2017-09 Impact factor: 7.124