Clinical

Transcutaneous bilirubin predicts later hyperbilirubinemia in infants

Last Updated: 2009-10-02 15:46:01 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Transcutaneous bilirubin measurement, combined with gestational age and exclusive breastfeeding, improves the prediction of subsequent hyperbilirubinemia in newborns about to be sent home from a well baby nursery, according to a report in the September Journal of Perinatology.

Dr. M. J. Maisels and colleagues from William Beaumont Hospital, Royal Oak, Michigan, evaluated a variety of predictive models in an effort to identify a simple, clinically relevant way to assess an infant's risk of developing hyperbilirubinemia.

The researchers identified 75 newborns who had been discharged from the well baby nursery and later readmitted with hyperbilirubinemia. When they compared these babies to 75 infants who had not been readmitted, they found, on logistic regression analysis, that predischarge transcutaneous bilirubin percentile group, feeding method, and gestational age group significantly predicted subsequent hyperbilirubinemia.

The authors note that transcutaneous bilirubin measurements from the mid-sternum are routinely obtained on all infants in their well baby nursery.

The combination of all 3 variables (transcutaneous bilirubin percentile, gestational age, and exclusive breastfeeding) was significantly better than any single variable in predicting subsequent hyperbilirubinemia, the researchers found.

Adding the birth weight and calculated rise of bilirubin level or substituting the last measured transcutaneous bilirubin level for the peak transcutaneous bilirubin level did not significantly change the effectiveness of the model, according to the authors.

Based on these findings, the investigators conclude that "routine predischarge transcutaneous bilirubin measurements, obtained by the nursing staff in a busy nursery, when combined with the infant's gestation and the method of feeding, provide a simple and relevant measure of the risk for the subsequent development of hyperbilirubinemia."

The paper acknowledges that Dr. Maisels receives consulting fees and grant support from Drager Medical, which manufactures the transcutaneous jaundice meter used in this study.

J Perinatol 2009;29:612-617.