Transcutaneous bilirubin nomogram for evaluating the risk of hyperbilirubinemia in Iranian healthy newborns

Background Hyperbilirubinemia,which is mostly benign,is one of the most common problems in neonates.This study was conducted to draw a skin bilirubin nomogram for evaluating the risk of hyperbilirubinemia requiring treatment.Methods This cross-sectional study recruited 1066 healthy infants.The first transcutaneous bilirubin(TcB)measurement was performed before hospital discharge and within 12-48 h of birth.The neonates were followed up for 6 days after discharge based on their age at the time of discharge.The neonates were divided into four groups based on the TcB values before discharge and age in hours,including the low-risk,medium-low-risk,medium-high-risk and high-risk groups.The percentage of neonates who progressed toward severe hyperbilirubinemia was then calculated in each percentile based on the follow-up TcB measurement.Stata software was used to draw the nomogram.Based on the TcB values at discharge and the neonate's age in hours,the skin bilirubin nomogram was drawn in 40,75 and 95 percentiles.Results A total of 4.9%of the neonates were in the high-risk group,18.9%in the medium-high-risk group,34.8%in the medium-low-risk group and 41.2%in the low-risk group.The risk of severe jaundice in the follow-up of the neonates in the highest-risk to the lowest-risk groups was 48.9,14.5,9.7 and 3.3%,respectively.Conclusion The skin bilirubin nomogram can be used to predict severe hyperbilirubinemia in Iranian infants.

新生儿经皮小时胆红素百分位曲线预测新生儿高胆红素血症价值的系统评价

目的对不同国家新生儿经皮小时胆红素百分位曲线预测新生儿高胆红素血症价值的文献进行系统评价,为新生儿高胆红素血症的诊治提供依据。方法检索Cochrane图书馆、PubMed、OVID、Springer数据库、中国期刊全文数据库、维普数据库、万方数据库和中国生物医学文献数据库,检索时间均从1990年1月至2011年3月。由2名系统评价员进行资料提取和质量评价。结果 10项研究进入分析,偏倚评价为B级6项、C级4项。不同国家制备的新生儿小时胆红素百分位曲线值有一定的差异,印度的小时胆红素百分位曲线值最高,希腊、以色列、中国次之,美国最低。在高度危险区（P95）,胆红素上升速度在生后24 h内最快;中度（P75）和低度（P40或P50）危险区,生后36 h内胆红素上升速度最快,其中印度上升速度最快最高,中国、美国、以色列次之,希腊上升速度最低。新生儿经皮小时胆红素百分位曲线预测高胆红素血症,高度危险区的敏感度为26.9%~75.0%,特异度为89.4%~97.3%;中度危险区的敏感度为78.7%~100.0%,特异度为48.3%~82.3%;低度危险区的敏感度为98.7%~100.0%,特异度为24.4%~56.1%;曲线下面积为0.766~0.990,其中泰国预测的准确性最高,印度、中国次之,美国最低。结论经皮小时胆红素百分位曲线图预测新生儿高胆红素血症有较高的准确性,具有临床推广应用价值。不同国家经皮小时胆红素百分位曲线有一定的差异,各国应根据本国新生儿小时总胆红素的变化趋势制备各自相对应的曲线图作为新生儿高胆红素血症的干预参考标准。

健康新生儿经皮小时胆红素百分位列线图预测高胆红素血症的价值

目的绘制健康新生儿小时经皮胆红素（TCB）百分位列线图,评价其在预测高胆红素血症发生风险中的价值。方法选取5250名足月儿或晚期早产儿（胎龄≥35周,出生体重≥2000g）,连续记录生后168hTCB值。将生后24~48h、49~72h和73~96h内对应最高危区TCB值作为预测指标,采用小时TCB列线图结合受试者工作特征曲线（ROC曲线）评价小时TCB列线图对高胆红素血症的预测价值。结果小时TCB百分位列线图显示,生后16~72hTCB快速上升明显,72h后至144h上升逐渐减缓,144h后维持一个平稳高值,其中第95百分位（P95）小时胆红素在96h已趋于稳定。P40、P75、P95小时TCB高峰值分别为173、217、248μmol/L。生后24~48h、49~72h和73~96h内TCB水平预测高胆红素血症ROC曲线下面积（AUC）分别为0.77、0.85和0.87。24~48h、49~72h和73~96h内高危区预测新生儿高胆红素血症患病率分别为35.03%、43.35%和79.95%,阳性似然比分别为3.35、4.75和22.70。结论小时TCB百分位列线图结合TCB值危险区的划分可较好预测新生儿高胆红素血症的发生。73~96h内小时胆红素若处于高危区,73~96h后有较大可能发生高胆红素血症。