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Israel transcutaneous bilirubin nomogram predicts significant hyperbilirubinemia
R Bromiker1,2, A Goldberg2, M Kaplan1,2
1Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel.
Insights
This study developed a transcutaneous bilirubin (TcB) nomogram for the Israeli population, identifying newborns above the 75th percentile as high risk for phototherapy due to hyperbilirubinemia.
Area of Science:
- Neonatal Medicine
- Pediatrics
- Public Health
Background:
- Hyperbilirubinemia is a common condition in newborns.
- Accurate risk assessment is crucial for timely phototherapy.
- Existing nomograms may not represent diverse populations.
Purpose of the Study:
- To construct and validate a transcutaneous bilirubin (TcB) nomogram for major Israeli population sectors.
- To assess the risk of hyperbilirubinemia requiring phototherapy based on percentile categories.
- To identify optimal thresholds for predicting phototherapy needs.
Main Methods:
- Daily TcB measurements using Drager JM-103 devices in newborns >= 36 weeks gestation.
- Construction of a nomogram divided into four risk groups.
- Validation of the nomogram by calculating phototherapy requirements per risk group.
Main Results:
- A total of 3303 measurements from 1059 newborns representing diverse Israeli ethnic groups were analyzed.
- Phototherapy risk increased significantly with higher TcB percentiles, exceeding 100-fold for the >95th percentile group compared to the <40th percentile group.
- The >75th percentile demonstrated optimal discrimination for phototherapy need (sensitivity 93.33%, specificity 59.47%).
Conclusions:
- The risk of significant hyperbilirubinemia and the need for phototherapy increase progressively with higher TcB percentiles.
- Newborns in the >75th percentile TcB risk groups require close monitoring for potential phototherapy.
- This TcB nomogram provides a valuable tool for risk stratification in the Israeli neonatal population.
Objective:
We constructed a transcutaneous bilirubin (TcB) nomogram to represent major sectors of the Israeli population. We studied the risk of hyperbilirubinemia, defined as meeting the requirements for phototherapy, per percentile risk category.
Study Design:
Newborns ⩾36 weeks gestation were tested daily for TcB, using Drager JM-103 devices, during birth hospitalization. A nomogram was constructed and divided into four risk groups and validated by calculating the need for phototherapy for each group.
Results:
A total of 3303 measurements were performed on 1059 consecutive newborns including Ashkenazi, Sephardic and mixed Ashkenazi/Sephardic Jews, Arab and Ethiopian Jewish. Phototherapy risk increased progressively and more than 100-fold, from 0/225 in the <40th percentile group through 27/120 (22.5%) for those >95th percentile (relative risk (95% confidence interval) 102 (6 to 1669) for those >95th percentile compared with those <40th percentile). The optimal risk for discriminating the need for phototherapy was >75th percentile (sensitivity 93.33, specificity 59.47).
Conclusion:
The risk of significant hyperbilirubinemia increased progressively with increasing percentile. Newborns >75th percentile groups are at high risk for phototherapy and should be closely monitored.
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