Prediction of Neonatal Hyperbilirubinemia with Transcutaneous Bilirubin Measurement
Date Issued
2004
Date
2004
Author(s)
Lin, Ming-Chih
DOI
en-US
Abstract
Background:
Early prediction of hyperbilirubinemia has regained attention in recent years partly because kernicterus and minor neurological abnormalities has occasionally been reported, and partly because of early discharge due to the change of managed care policy.
Objectives:
The aims of this thesis were (1) to build up the nomogram of Taiwanese infants, (2) to predict neonatal hyperbilirubinemia by conventional models and a five-state transition model, and (3) to analyze their related risk factors.
Materials and Methods:
A hospital-based prospective cohort study consisted of 531 infants were term or near-term infants eligible for caring at the well-baby nursery. All infants’ transcutaneous bilirubin (TcB) were recorded regularly at least every 8 hours. Birth weights, maternal age, sex, presence of ABO incompatibility, feeding method, type of delivery, gestational history, and body weight change were recorded. All babies were invited to come back to follow-up clinic after discharge. Nomogram was plotted according to percentile data at a four-hour interval. Sensitivity, specificity, and receiver operator characteristic (ROC) curve were analyzed at age of 24 and 48 hours old. A five-state transition model was built to predict the progression or regression of bilirubin level. Risk factors were analyzed by both linear mixed model , generalized linear mixed model, proportional hazards transitional model. Later-onset neonatal hyperbilirubinemia was analyzed by logistic regression model.
Results:
According to hour-specific nomogram, infants reached their peak bilirubin level at mean and median age of 79.5 and 76 hours old. Both mean and median peak bilirubin level were about 13.7 mg/dL. Infants received phototherapy at a mean and median age of 80 and 76-hour-old. The areas under ROC cure were 0.873 for predicting need for phototherapy and 0.844 for clinically significant jaundice at age of 48-hour-old. The areas under ROC cure were both 0.773 at 24-hour-old. Non-homogenous process by the division of 48 hours may be a critical point for differentiating transition rate in the transition model. First pregnancy and ABO incompatibility were two risk factors attributed to biological reasons.
Conclusion:
The present study used a series of TcB measurement to predict hyperbilirubinemia or the need for phototherapy using conventional method or a novel five-state transition model. The results found 48-hour-old TcB level may be a good predictor. Primiparity, incompatibility of ABO blood type, and G6PD deficiency were significant risk factors. Other established significant factors were largely influenced by the neonatal care policy of national health insurance.
All infants should receive non-invasive bilirubin measurement before discharge. High risk infants should be followed up within several days after discharge.
Subjects
經皮式黃疸測定
預測
黃疸
新生兒
neonate
hyperbilirubinemia
transcutaneous bilirubin measurement
prediction
Type
thesis
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