Predischarge screening for severe neonatal hyperbilirubinemia identifies infants who need phototherapy

Vinod K. Bhutani, Ann R. Stark, Laura C. Lazzeroni, Ronald Poland, Glenn R. Gourley, Steven (Steve) Kazmierczak, Linda Meloy, Anthony E. Burgos, Judith Y. Hall, David K. Stevenson

Research output: Contribution to journalArticle

81 Citations (Scopus)

Abstract

Objective: To test whether the combined use of total plasma/serum bilirubin (TSB) levels and clinical risk factors more accurately identifies infants who receive phototherapy than does the use of either method alone. Study design: We recruited healthy infants of ≥35 weeks' gestation at 6 centers that practiced universal predischarge TSB screening. Transcutaneous bilirubin (TcB) was measured at 24 hours, with TSB at 24-60 hours and at 3- to 5- and 7- to 14-day follow-up visits. Clinical risk factors were identified systematically. Results: Of 1157 infants, 1060 (92%) completed follow-up, and 982 (85%) had complete datasets for analysis. Infant characteristics included 25% were nonwhite and 55% were Hispanic/Latino; >90% were breastfed. During the first week, jaundice was documented in 84% of subjects. Predischarge TSB identified the 41 (4.2%) and 34 (3.5%) infants who received phototherapy before and after discharge, respectively. Prediction of postdischarge phototherapy was similar for combined clinical risk factors (earlier gestational age [GA], bruising, positive direct antiglobulin test, Asian race, exclusive breastfeeding, blood type incompatibility, jaundice extent) and age-adjusted TSB (area under the curve [AUC] = .86 vs.87), but combined screening was better (AUC = .95). TcB/TSB combined with GA alone was equally predictive (AUC = .95; 95% CI.93-.97). Conclusions: Jaundice is present in 4 of 5 (84%) healthy newborns. Predischarge TcB/TSB (adjusted for postnatal age) combined with specific clinical factors (especially GA) best predicts subsequent phototherapy use. Universal implementation of this strategy in the US should improve outcomes of healthy newborns discharged early.

Original languageEnglish (US)
JournalJournal of Pediatrics
Volume162
Issue number3
DOIs
StatePublished - Mar 2013

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Neonatal Hyperbilirubinemia
Phototherapy
Bilirubin
Serum
Jaundice
Gestational Age
Area Under Curve
Hispanic Americans
Newborn Infant
Coombs Test
Breast Feeding

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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Predischarge screening for severe neonatal hyperbilirubinemia identifies infants who need phototherapy. / Bhutani, Vinod K.; Stark, Ann R.; Lazzeroni, Laura C.; Poland, Ronald; Gourley, Glenn R.; Kazmierczak, Steven (Steve); Meloy, Linda; Burgos, Anthony E.; Hall, Judith Y.; Stevenson, David K.

In: Journal of Pediatrics, Vol. 162, No. 3, 03.2013.

Research output: Contribution to journalArticle

Bhutani, VK, Stark, AR, Lazzeroni, LC, Poland, R, Gourley, GR, Kazmierczak, SS, Meloy, L, Burgos, AE, Hall, JY & Stevenson, DK 2013, 'Predischarge screening for severe neonatal hyperbilirubinemia identifies infants who need phototherapy', Journal of Pediatrics, vol. 162, no. 3. https://doi.org/10.1016/j.jpeds.2012.08.022
Bhutani, Vinod K. ; Stark, Ann R. ; Lazzeroni, Laura C. ; Poland, Ronald ; Gourley, Glenn R. ; Kazmierczak, Steven (Steve) ; Meloy, Linda ; Burgos, Anthony E. ; Hall, Judith Y. ; Stevenson, David K. / Predischarge screening for severe neonatal hyperbilirubinemia identifies infants who need phototherapy. In: Journal of Pediatrics. 2013 ; Vol. 162, No. 3.
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abstract = "Objective: To test whether the combined use of total plasma/serum bilirubin (TSB) levels and clinical risk factors more accurately identifies infants who receive phototherapy than does the use of either method alone. Study design: We recruited healthy infants of ≥35 weeks' gestation at 6 centers that practiced universal predischarge TSB screening. Transcutaneous bilirubin (TcB) was measured at 24 hours, with TSB at 24-60 hours and at 3- to 5- and 7- to 14-day follow-up visits. Clinical risk factors were identified systematically. Results: Of 1157 infants, 1060 (92{\%}) completed follow-up, and 982 (85{\%}) had complete datasets for analysis. Infant characteristics included 25{\%} were nonwhite and 55{\%} were Hispanic/Latino; >90{\%} were breastfed. During the first week, jaundice was documented in 84{\%} of subjects. Predischarge TSB identified the 41 (4.2{\%}) and 34 (3.5{\%}) infants who received phototherapy before and after discharge, respectively. Prediction of postdischarge phototherapy was similar for combined clinical risk factors (earlier gestational age [GA], bruising, positive direct antiglobulin test, Asian race, exclusive breastfeeding, blood type incompatibility, jaundice extent) and age-adjusted TSB (area under the curve [AUC] = .86 vs.87), but combined screening was better (AUC = .95). TcB/TSB combined with GA alone was equally predictive (AUC = .95; 95{\%} CI.93-.97). Conclusions: Jaundice is present in 4 of 5 (84{\%}) healthy newborns. Predischarge TcB/TSB (adjusted for postnatal age) combined with specific clinical factors (especially GA) best predicts subsequent phototherapy use. Universal implementation of this strategy in the US should improve outcomes of healthy newborns discharged early.",
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AU - Bhutani, Vinod K.

AU - Stark, Ann R.

AU - Lazzeroni, Laura C.

AU - Poland, Ronald

AU - Gourley, Glenn R.

AU - Kazmierczak, Steven (Steve)

AU - Meloy, Linda

AU - Burgos, Anthony E.

AU - Hall, Judith Y.

AU - Stevenson, David K.

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N2 - Objective: To test whether the combined use of total plasma/serum bilirubin (TSB) levels and clinical risk factors more accurately identifies infants who receive phototherapy than does the use of either method alone. Study design: We recruited healthy infants of ≥35 weeks' gestation at 6 centers that practiced universal predischarge TSB screening. Transcutaneous bilirubin (TcB) was measured at 24 hours, with TSB at 24-60 hours and at 3- to 5- and 7- to 14-day follow-up visits. Clinical risk factors were identified systematically. Results: Of 1157 infants, 1060 (92%) completed follow-up, and 982 (85%) had complete datasets for analysis. Infant characteristics included 25% were nonwhite and 55% were Hispanic/Latino; >90% were breastfed. During the first week, jaundice was documented in 84% of subjects. Predischarge TSB identified the 41 (4.2%) and 34 (3.5%) infants who received phototherapy before and after discharge, respectively. Prediction of postdischarge phototherapy was similar for combined clinical risk factors (earlier gestational age [GA], bruising, positive direct antiglobulin test, Asian race, exclusive breastfeeding, blood type incompatibility, jaundice extent) and age-adjusted TSB (area under the curve [AUC] = .86 vs.87), but combined screening was better (AUC = .95). TcB/TSB combined with GA alone was equally predictive (AUC = .95; 95% CI.93-.97). Conclusions: Jaundice is present in 4 of 5 (84%) healthy newborns. Predischarge TcB/TSB (adjusted for postnatal age) combined with specific clinical factors (especially GA) best predicts subsequent phototherapy use. Universal implementation of this strategy in the US should improve outcomes of healthy newborns discharged early.

AB - Objective: To test whether the combined use of total plasma/serum bilirubin (TSB) levels and clinical risk factors more accurately identifies infants who receive phototherapy than does the use of either method alone. Study design: We recruited healthy infants of ≥35 weeks' gestation at 6 centers that practiced universal predischarge TSB screening. Transcutaneous bilirubin (TcB) was measured at 24 hours, with TSB at 24-60 hours and at 3- to 5- and 7- to 14-day follow-up visits. Clinical risk factors were identified systematically. Results: Of 1157 infants, 1060 (92%) completed follow-up, and 982 (85%) had complete datasets for analysis. Infant characteristics included 25% were nonwhite and 55% were Hispanic/Latino; >90% were breastfed. During the first week, jaundice was documented in 84% of subjects. Predischarge TSB identified the 41 (4.2%) and 34 (3.5%) infants who received phototherapy before and after discharge, respectively. Prediction of postdischarge phototherapy was similar for combined clinical risk factors (earlier gestational age [GA], bruising, positive direct antiglobulin test, Asian race, exclusive breastfeeding, blood type incompatibility, jaundice extent) and age-adjusted TSB (area under the curve [AUC] = .86 vs.87), but combined screening was better (AUC = .95). TcB/TSB combined with GA alone was equally predictive (AUC = .95; 95% CI.93-.97). Conclusions: Jaundice is present in 4 of 5 (84%) healthy newborns. Predischarge TcB/TSB (adjusted for postnatal age) combined with specific clinical factors (especially GA) best predicts subsequent phototherapy use. Universal implementation of this strategy in the US should improve outcomes of healthy newborns discharged early.

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