Prediction of the need for phototherapy during hospital stay in preterm infants by transcutaneous bilirubinometry
Abstract
Background: Neonatal hyperbilirubinemia is a common condition that frequently requires treatment with phototherapy and less commonly by exchange transfusion, especially in preterm infants. It is important to identify and monitor infants at risk of severe unconjugated hyperbilirubinemia early in the postnatal period to instigate appropriate management plans.
Aims: To evaluate transcutaneous bilirubinometry (TCB) as a screening tool at 24 and 48 h of age to predict the need for phototherapy during hospital stay in preterm infants. Study design: A single centre prospective cohort study in a level III perinatal centre.
Subjects: Preterm infants (23(+0) to 36(+6) weeks of gestation) were eligible for enrolment. Outcome measures: Primary outcome was to assess the predictive value of TCB at 24 and 48 h of age for the need of phototherapy during hospital stay.
Results: A total of 338 preterm infants were enrolled. The majority of infants (98.1%) born below 32 weeks of gestation required phototherapy.
For infants born at > 31 + 6 weeks of gestation, TCB at 24 h of age >= 81 mu mol/l had sensitivity 83%, specificity 56%, positive predictive value (PPV) 54.7% and negative predictive value (NPV) 84%. TCB at 48 h of age >= 145 mu mol/l had sensitivity 65%, specificity 62%, PPV 24% and NPV 90%.
Conclusion: TCB performed poorly at 24 and 48 h of age as a predictor of phototherapy during hospital stay in preterm infants. The negative predictive value of the test at 48 h of age might be helpful for infants born after 31 + 6 weeks of gestation.