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Transcutaneous Microcirculatory Imaging in Preterm Neonates
Published on: December 31, 2015
Neonatal bilirubin triage with transcutaneous meters: when is a blood draw necessary?
Claire Hoppenot1, Gary A Emmett
1Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Insights
A transcutaneous bilirubin (TcB) screening level below 8 mg/dL in term newborns is safe for discharge, minimizing phlebotomy. A TcB cutoff up to 12 mg/dL is also viable for universal follow-up strategies.
Area of Science:
- Neonatal Medicine
- Pediatrics
- Medical Diagnostics
Background:
- Hyperbilirubinemia is a common condition in newborns.
- Accurate screening is crucial to prevent severe outcomes.
- Transcutaneous bilirubinometry offers a non-invasive screening method.
Purpose of the Study:
- To determine the optimal transcutaneous bilirubin (TcB) screening threshold in term neonates.
- To balance the need to prevent harm from hyperbilirubinemia with minimizing unnecessary procedures like phlebotomy.
- To evaluate cost-effectiveness in neonatal jaundice management.
Main Methods:
- Retrospective chart review of TcB and total serum bilirubin (TSB) measurements in term newborns (27-51 hours of life).
- Analysis of Negative Predictive Values (NPVs) for TcB cutoffs ranging from 6 to 12 mg/dL.
- Evaluation against the Bhutani TSB risk nomogram for high-risk (HR) and high-intermediate/HR categories.
Main Results:
- A TcB cutoff of < 8 mg/dL demonstrated a 99.9% NPV for high risk (HR), with only 1 in 759 infants identified as HR.
- TCB levels < 7 mg/dL had a 100% NPV for HR.
- A TcB cutoff of 12 mg/dL showed NPVs of 99.3% for HR and 92.7% for high-intermediate/HR.
Conclusions:
- Term infants with TcB < 8 mg/dL can be safely discharged without follow-up TSB, acknowledging a minimal risk (-1/1000) of severe hyperbilirubinemia.
- Institutions can consider TcB cutoffs up to 12 mg/dL for universal follow-up protocols.
- The choice of TcB cutoff should align with institutional confidence in newborn follow-up procedures.
Objective:
To find the optimal transcutaneous bilirubin (TcB) screening level in term neonates that minimizes the discomfort of phlebotomy, while protecting the child from harm and controlling costs.
Methods:
All available TcB and total serum bilirubin (TSB) measurements taken between 27 and 51 hours of life from a cohort of term newborns were analyzed in a retrospective chart review. TcB cutoffs between 6 and 12 mg/dL were evaluated for their negative predictive values (NPVs) for high risk (HR) and for the combination of high-intermediate risk and HR on the Bhutani TSB risk nomogram.
Results:
One thousand seventy-one full-term newborns were entered into the study. Of 601 newborns with TcB < 7 mg/dL, none were HR by TSB. Of newborns with a TcB of < 8 mg/dL, 1 in 759 was HR. The NPVs for screening levels of 7 and 8 mg/dL were of 100% and 99.9%, respectively, for HR and 99% and 97.60%, respectively, for high-intermediate/HR. A cutoff at 12 mg/dL had NPVs of 99.3% for HR, with 7 neonates, and 92.7% for high-intermediate/HR, with 76 infants of 1041.
Conclusions:
In our center, term infants with a TcB of < 8 mg/dL may be safely discharged without a follow-up TSB, with the understanding that -1/1000 infants may be at HR for developing severe hyperbilirubinemia. Practices with universal follow-up may safely choose cutoffs up to 12 mg/dL. An institution's degree of comfort and confidence in follow-up of the newborn cohort will guide the choice of an appropriate TcB cutoff requiring a TSB.
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