Background: The American Academy of Pediatrics has recommended a systematic assessment before discharge for the risk of severe hyperbilirubinemia. Plotting total serum bilirubin (TSB) or transcutaneous bilirubin (TcB) on a TSB hour-specific nomogram is proposed as a tool for laboratory evaluation. Objectives: The aim of this study was to compare the predictive characteristics, particularly the incidence of false negative rate (FNR), of the practice of plotting TcB values on the TSB hour-specific risk nomogram versus on transcutaneous nomogram. Methods: Paired TSB and TcB measurements were conducted on 141 newborns. Risk of developing significant hyperbilirubinemia was defined as infants with bilirubin level ≥75% on TSB or ≥95% on TcB nomogram. TSB values, plotted on the TSB nomogram of Bhutani et al. [Pediatrics 1999;103:6-14], were used as reference. TcB values were plotted on the TSB nomogram and on the transcutaneous nomograms of Maisels and Kring [Pediatrics 2006;117:1169-1173] and Fouzas et al. [Pediatrics 2010;125:e52-e57]. Results: Plotting TcB measurements on a TSB nomogram resulted in a trend towards a higher FNR when compared to Maisels' and Fouzas' nomograms (18.0/1,000 compared to 10.2/1,000 and 8.6/1,000 respectively). Although not statistically significant, plotting TcB on transcutaneous nomogram resulted in better predictive values with the Fouzas' nomogram, having the best sensitivity (90.0%) and specificity (87.79%) as well as the highest positive (35.97%) and negative (99.14%) predictive value. Conclusion: Plotting TcB on a TSB nomogram may result in increased rate of FNR and decreased predictive characteristics. The practice of plotting TcB on a TSB nomogram needs further evaluation.

Keywords:
Transcutaneous bilirubin, Hyperbilirubinemia, Jaundice, Neonates, Predictive nomogram
1.
American Academy of Pediatrics Subcommittee of Hyperbilirubinemia: Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics 2004;114:297-316.
2.
Bhutani VK, Johnson L, Sivieri EM: Predictive ability of a predischarge hour-specific serum bilirubin for subsequent significant hyperbilirubinemia in healthy term and near-term newborns. Pediatrics 1999;103:6-14.
3.
Maisels MJ, Bhutani VK, Bogen D, Newman TB, Stark AR, Watchko JF: Hyperbilirubinemia in the newborn infant ≥35 weeks' gestation: an update with clarifications. Pediatrics 2009;124:1193-1198.
4.
Barrington KJ, Sankaran K; Canadian Paediatric Society Fetus and Newborn Committee: Guidelines for detection, management and prevention of hyperbilirubinemia in term and late preterm newborn infants. Position Statement (FN-2007-02 and reaffirmed 2011). Paediatr Child Health 2007;12(suppl B):1B-12B.
5.
Tayaba R, Gribetz D, Gribetz I, Holzman IR: Noninvasive estimation of serum bilirubin. Pediatrics 1998;102:E28.
6.
Carceller-Blanchard A, Cousineau J, Delvin EE: Point of care testing: transcutaneous bilirubinometry in neonates. Clin Biochem 2009;42:143-149.
7.
Carceller AM, Delvin E, Gonthier M, Grégoire MC, Cousineau J, Alexandrov L: Évaluation de la mesure transcutanée de la bilirubin et concordance avec la mesure sur sang total et plasma. Ann Biol Clin 2006;64:1-5.
8.
Ip S, Chung M, Kulig J, O'Brien R, Sege R, Glicken S, et al: An evidence-based review of important issues concerning neonatal hyperbilirubinemia. Pediatrics 2004;114:e130-e153.
9.
Maisels MJ, Kring E: Transcutaneous bilirubin levels in the first 96 hours in a normal newborn population of ≥35 weeks' gestation. Pediatrics 2006;117:1169-1173.
10.
Fouzas S, Mantagou L, Skylogianni E, Mantagos S, Varvarigou A: Transcutaneous bilirubin levels for the first 120 postnatal hours in healthy neonates. Pediatrics 2010;125:e52-e57.
11.
Sanpavat S, Nuchprayoon I, Smathakanee C, Hansuebsai R: Nomogram for prediction of the risk of neonatal hyperbilirubinemia, using transcutaneous bilirubin. J Med Assoc Thai 2005;88:1187-1193.
12.
De Luca D, Romagnoli C, Tiberi E, Zuppa AA, Zecca E: Skin bilirubin nomogram for the first 96 h of life in a European normal healthy newborn population, obtained with multiwavelength transcutaneous bilirubinometry. Acta Paediatr 2008;97:146-150.
13.
Engle WD, Lai S, Ahmad N, Manning MD, Jackson GL: An hour-specific nomogram for transcutaneous bilirubin values in term and late preterm Hispanic neonates. Am J Perinatol 2009;26:425-430.
14.
De Luca D, Jackson GL, Tridente A, Carnielli VP, Engle WD: Transcutaneous bilirubin nomogram. A systematic review of population differences and analysis of bilirubin kinetics. Arch Pediatr Adolesc Med 2009;163:1054-1059.
15.
Varvarigou A, Fouzas S, Skylogianni E, Mantagou L, Bougioukou D, Mantagos S: Transcutaneous bilirubin nomogram for prediction of significant neonatal hyperbilirubinemia. Pediatrics 2009;124:1052-1059.
16.
Bhutani VK, Gourley GR, Adler S, Kreamer B, Dalin C, Johnson LH: Noninvasive measurement of total serum bilirubin in a multiracial predischarge newborn population to assess the risk of severe hyperbilirubinemia. Pediatrics 2000;106:E17.
17.
Slaughter J, Annibale D, Suresh GK: False-negative results of predischarge neonatal bilirubin screening to predict severe hyperbilirubinemia: a need for caution. Eur J Pediatr 2009;168:1461-1466.
18.
Rodriguez-Capote K, Kim K, Paes B, Turner D, Grey V: Clinical implication of the difference between transcutaneous bilirubinometry and total serum bilirubin for the classification of newborns at risk of hyperbilirubinemia. Clin Biochem 2009;42:176-179.
19.
Bromiker R, Bin-Nun A, Schimmel MS, Hammerman C, Kaplan M: Neonatal hyperbilirubinemia in the low-intermediate-risk category on the bilirubin nomogram. Pediatrics 2012;130:e470-e475.
20.
Bental YA, Shiff Y, Dorsht N, Litig E, Tuval L, Mimouni FB: Bhutani-based nomogram for the prediction of significant hyperbilirubinaemia using transcutaneous measurements of bilirubin. Acta Paediatr 2009;98:1902-1908.
21.
BiliChek Noninvasive Bilirubin Analyzer. Suggested Usage Protocol. Respironics. http://www.olusummedikal.com/bili/33.pdf (accessed December 8, 2013).
22.
Statistisques. http://www.medcalc.owrg/calc/diagnostic_test.php and http://vassarstats.net/index.html (accessed December 8, 2013).
23.
Fay DL, Schellhase KG, Suresh GK: Bilirubin screening for normal newborns: a critique of the hour-specific bilirubin nomogram. Pediatrics 2009;124:1203-1205.
24.
Bhutani VK, Vilms RJ, Hamerman-Johnson L: Universal bilirubin screening for severe neonatal hyperbilirubinemia. J Perinatol 2010;30:S6-S15.
25.
Mantagou L, Fouzas S, Skylogianni E, Giannakopoulos I, Karatza A, Varvarigou A: Trends of transcutaneous bilirubin in neonates who develop significant hyperbilirubinemia. Pediatrics 2012;130:e898-e904.
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2014
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