已入深夜,您辛苦了!由于当前在线用户较少,发布求助请尽量完整地填写文献信息,科研通机器人24小时在线,伴您度过漫漫科研夜!祝你早点完成任务,早点休息,好梦!

Predictive Ability of a Predischarge Hour-specific Serum Bilirubin for Subsequent Significant Hyperbilirubinemia in Healthy Term and Near-term Newborns

医学 列线图 百分位 胎龄 胆红素 儿科 人口 内科学 怀孕 统计 数学 环境卫生 生物 遗传学
作者
Vinod K. Bhutani,Lois Johnson,Emidio M. Sivieri
出处
期刊:Pediatrics [American Academy of Pediatrics]
卷期号:103 (1): 6-14 被引量:838
标识
DOI:10.1542/peds.103.1.6
摘要

Objective. To assess the predictive ability of a universal predischarge serum bilirubin measurement to screen for risk of subsequent significant hyperbilirubinemia in the direct Coombs negative healthy term and near-term newborn during the first postnatal week. Methods. Total serum bilirubin (TSB) levels were obtained at the time of the routine metabolic screen in all term and near-term newborns cared for in the Pennsylvania Hospital Well Baby Nursery (n = 13 003). Postnatal age (in hours) at the time of TSB measurement was recorded. A percentile-based bilirubin nomogram for the first week was constructed from hour-specific predischarge and postdischarge TSB values of newborns (n = 2840; median BW = 3230 g and median gestational age = 39 weeks) who met classification criteria for healthy newborns (excluding those with a positive direct Coombs test or those requiring phototherapy before age 60 hours) and who were enrolled in a hospital supervised home or outpatient follow-up program. The accuracy of the predischarge TSB as a predictor of subsequent degree of hyperbilirubinemia was determined. Results. The study patients in the nomogram were racially diverse. Nearly 60% were breastfed. Predischarge, 6.1% of the study population (172/2840) had TSB values in the high-risk zone (≥95th percentile) at 18 to 72 hours; of these, 39.5% (68/172) remained in that zone (likelihood ratio [LR] = 14.08, sensitivity = 54%; specificity = 96.2%, probability = 39.5%). Predischarge, 32.1% of the population (912/2840) had TSB values in the intermediate-risk zone. In a clinically significant minority of these newborns (58/912 or 6.4%), the postdischarge TSB moved into the high-risk zone (LR of this move: 3.2 from the upper-intermediate zone and .48 from the lower-intermediate risk zone). The predischarge TSB in 61.8% of the newborns (1756/2840) was in the low-risk zone (<40th percentile) and there was no measurable risk for significant hyperbilirubinemia (LR = 0, sensitivity = 100%; specificity = 64.7%; probability = 0%). Conclusions. An hour-specific TSB before hospital discharge can predict which newborn is at high, intermediate or low risk for developing clinically significant hyperbilirubinemia (specifically defined as TSB levels ≥95th percentile for age in hours). Risk designation and subsequent increases or decreases of in TSB can be easily monitored on an hour-specific percentile based predictive bilirubin nomogram. A predischarge TSB measured as a universal policy would facilitate targeted intervention and follow-up in a safe, cost-effective manner. In conjunction with bilirubin practice parameter of the American Academy of Pediatrics, it could reduce the potential risk for bilirubin-induced neurologic dysfunction.
最长约 10秒,即可获得该文献文件

科研通智能强力驱动
Strongly Powered by AbleSci AI
更新
PDF的下载单位、IP信息已删除 (2025-6-4)

科研通是完全免费的文献互助平台,具备全网最快的应助速度,最高的求助完成率。 对每一个文献求助,科研通都将尽心尽力,给求助人一个满意的交代。
实时播报
1秒前
小富婆完成签到 ,获得积分10
3秒前
小二郎应助mxm12138采纳,获得30
4秒前
4秒前
白茶完成签到 ,获得积分10
9秒前
笨笨千亦发布了新的文献求助10
12秒前
淡然的舞仙完成签到 ,获得积分10
13秒前
orixero应助momo采纳,获得10
17秒前
kk完成签到,获得积分10
17秒前
19秒前
19秒前
昏睡的傲菡完成签到 ,获得积分10
20秒前
Bob关闭了Bob文献求助
22秒前
23秒前
喽喽发布了新的文献求助10
23秒前
一直向前发布了新的文献求助10
23秒前
26秒前
淡然如风完成签到,获得积分10
27秒前
27秒前
前行者发布了新的文献求助10
28秒前
28秒前
28秒前
淡然如风发布了新的文献求助10
30秒前
豆包发布了新的文献求助10
32秒前
32秒前
围炉夜话完成签到,获得积分10
33秒前
33秒前
张二发布了新的文献求助10
33秒前
Jasper应助科研通管家采纳,获得10
34秒前
在水一方应助科研通管家采纳,获得10
34秒前
coolkid应助科研通管家采纳,获得10
34秒前
35秒前
乐乐应助科研通管家采纳,获得10
35秒前
35秒前
Owen应助科研通管家采纳,获得10
35秒前
35秒前
深情安青应助科研通管家采纳,获得10
35秒前
充电宝应助科研通管家采纳,获得10
35秒前
充电宝应助科研通管家采纳,获得10
35秒前
cf2v发布了新的文献求助10
37秒前
高分求助中
A new approach to the extrapolation of accelerated life test data 1000
ACSM’s Guidelines for Exercise Testing and Prescription, 12th edition 500
‘Unruly’ Children: Historical Fieldnotes and Learning Morality in a Taiwan Village (New Departures in Anthropology) 400
Indomethacinのヒトにおける経皮吸収 400
Phylogenetic study of the order Polydesmida (Myriapoda: Diplopoda) 370
基于可调谐半导体激光吸收光谱技术泄漏气体检测系统的研究 350
Robot-supported joining of reinforcement textiles with one-sided sewing heads 320
热门求助领域 (近24小时)
化学 材料科学 医学 生物 工程类 有机化学 生物化学 物理 内科学 纳米技术 计算机科学 化学工程 复合材料 遗传学 基因 物理化学 催化作用 冶金 细胞生物学 免疫学
热门帖子
关注 科研通微信公众号,转发送积分 3989832
求助须知:如何正确求助?哪些是违规求助? 3531967
关于积分的说明 11255613
捐赠科研通 3270725
什么是DOI,文献DOI怎么找? 1805035
邀请新用户注册赠送积分活动 882181
科研通“疑难数据库(出版商)”最低求助积分说明 809208