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      Correlación entre bilirrubina serica y bilirrubinometría transcutánea en neonatos estratificados por edad gestacional

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          Abstract

          Introducción: La ictericia neonatal es un dilema diagnóstico y terapéutico muy común. Las decisiones basadas en mediciones seriadas de bilirrubina sérica se asocian con dolor en el niño, tiempo de espera y ansiedad por los resultados. La bilirrubinometría transcutánea puede ser una alternativa confiable si se demuestra su validez para poblaciones e instituciones particulares. Objetivos: Establecer el grado de correlación entre bilirrubina sérica total (BST) y bilirrubina transcutánea (BTC) en neonatos estratificados por edad gestacional. Métodos: Estudio de diseño transversal. Cien recién nacidos ictéricos, 50 de término y 50 pretérmino, fueron analizados. A cada niño se le realizó una medición simultánea de BST y BTC. Luego se calcularon los coeficientes de variación de las medias, las diferencias de las medidas, la sensibilidad y el valor predictivo positivo de la BTC, los coeficientes de correlación, la ecuación de la línea de regresión, y la equivalencia de ambas mediciones para predecir el riesgo de hiperbilirrubinemia. Resultados: El coeficiente de variación de las medias fue similar para ambas mediciones (BST: 3,09%; BTC: 3,24%). Las mediciones de BST y BTC fueron diferentes en 95 niños, e iguales en 5 de ellos. En los 95 neonatos con lecturas divergentes, la BTC subestimó la BST en 59 y la sobreestimó en 36, con una diferencia promedio de 1,39 mg/dl (DE 0,58 mg/dl). La sensibilidad de la BTC para identificar una BST >12 mg/dl fue 87%, con un valor predictivo positivo de 94%. El coeficiente de correlación de toda la muestra fue 0,88; en los neonatos de término fue 0,92 y en los pretérmino fue 0,84. El 82% de los neonatos fueron correctamente clasificados por la BTC en los percentiles de riesgo para hiperbilirrubinemia significativa. Conclusiones: La precisión de las medidas de BST y BTC es similar en nuestra institución. Aunque hay una correlación aceptable entre ambos métodos de valoración, independientemente de la edad gestacional, la técnica de la BTC tiende a subestimar los valores de BST cuando éstos exceden la cifra de 12 mg/dl. La medición de BTC puede predecir la posibilidad de hiperbilirrubinemia significativa en la mayoría de los neonatos, por lo que su uso prudente antes del egreso hospitalario puede reducir este riesgo y a la vez prevenir procedimientos innecesarios.

          Translated abstract

          Background: Newborn jaundice with its potential for producing brain damage remains a continuing problem for pediatricians. Therapeutic decisions based on serial measurements of serum bilirubin (TSB) are time-consuming and associated with stress for the child, parents and practitioners. Transcutaneous bilirubinometry (TCB) may be an alternative method if its reliability is proven for a particular institution and population. Objective: to establish the degree of correlation between TSB and TCB in newborn infants classified by gestational age. Methods: cross-sectional study. 100 jaundiced infants, stratified into two groups of 50 preterm and 50 full-term newborns, were analyzed by simultaneous samples of TSB and TCB. Statistical analysis included estimates of differences between the two measurements, coefficients of variation of means, correlation coefficients, sensitivity and positive predictive value of TCB, and accuracy of TCB to predict significant hyperbilirubinemia Results: the coefficient of variation of means was similar for both methods (TSB: 3.09%; TCB: 3.24%). Measurements of TSB and TCB were different in 95 infants and equivalent in 5. TCB underestimated TSB in 59 measurements and overestimated it in 36 of them, with a mean difference of 1.39 mg/dl (SD 0.58 mg/dl). Sensitivity of TCB to identify a TSB >12 mg/dl was 87%, with a positive predictive value of 94%. The global correlation coefficient was 0.88 (term infants: 0.92; preterm infants: 0.84). 82% of the infants were correctly classified by the TCB within the percentiles of risk for significant hyperbilirubinemia. Conclusions: precision of measurements of TSB and TCB is similar in our institution. Despite a good correlation between the two methods, regardless the gestational age, TCB tends to underestimate TSB when bilirubin values go beyond 12 mg/dl. The TCB technique can accurately predict the risk of extreme hyperbilirubinemia, so it can be cautiously used prior to discharge to reduce this risk and to avoid unnecessary interventions.

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          Noninvasive measurement of total serum bilirubin in a multiracial predischarge newborn population to assess the risk of severe hyperbilirubinemia.

          Jaundice in near-term and term newborns is a frequent diagnosis that may prompt hospital readmission in the first postnatal week. Hyperbilirubinemia, when excessive, can lead to potentially irreversible bilirubin-induced neurotoxicity. Predischarge risk assessment (at 24-72 hours of age) for subsequent excessive hyperbilirubinemia is feasible by a laboratory-based assay of total serum bilirubin (TSB). Hypothesis. Noninvasive, transcutaneous, point-of-care measurement of transcutaneous bilirubin (TcB) predischarge by multiwavelength spectral analysis, using a portable BiliCheck device (SpectRx Inc, Norcross, GA), is clinically equivalent to measurement of TSB in a diverse, multiracial term and near-term newborn population and predictive of subsequent hyperbilirubinemia. We evaluated a hand-held device that uses multiwavelength spectral reflectance analysis to measure TcB (BiliCheck). The study population (490 term and near-term newborns) was racially diverse (59.1% white, 29.5% black, 3.46% Hispanic, 4.48% Asian, and 3.46% other) and was evaluated at 2 separate institutions using multiple (11) devices. The postnatal age ranged from 12 to 98 hours and the ranges of birth weights and gestational ages were 2000 to 5665 g and 35 to 42 weeks, respectively. All transcutaneous evaluations were performed contemporaneously and paired with a heelstick TSB measurement. All TSB assays were performed by high performance liquid chromatography, as well as by diazo dichlorophenyldiazonium tetrafluoroborate techniques. TSB values ranged from .2 to 18.2 mg/dL (mean +/- standard deviation: 7.65 +/- 3.35 mg/dL). The overall correlation of TSB (by high performance liquid chromatography technique) to TcB (by BiliCheck devices) was linear and statistically significant (r =.91; r(2) =.83; TcB =.84; TSB = +.75; standard error of regression line = 1.38; P /=15 mg/dL (>/=256 micromol/L).
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            System-based approach to management of neonatal jaundice and prevention of kernicterus.

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              Length of stay, jaundice, and hospital readmission.

              To evaluate the effect of postnatal age at the time of discharge on the risk of readmission to hospital with specific reference to readmission for hyperbilirubinemia. Case-control study based on chart review. Large suburban community hospital in southeastern Michigan, delivering more than 5000 infants annually. Newborn infants, born between December 1, 1988, and November 30, 1994, who were readmitted to hospital within 14 days of discharge, were compared with a randomly selected control group who were not readmitted. Of 29,934 infants discharged, 247 (0.8%) were readmitted by the age of 14 days. One hundred twenty-seven (51%) were admitted because of hyperbilirubinemia and 74 (30%) with the diagnosis of "rule out sepsis." The factors associated with an increased risk of readmission to the hospital were: infant of diabetic mother [odds ratios (OR), 3.45; 95% confidence limits (CL), 1.39 to 8.60]; gestation or = 40 weeks; presence of jaundice in the nursery (OR, 1.73; CL, 1.14 to 2.63); breastfeeding (OR, 1.78; CL, 1.13 to 2.81); male sex (OR, 1.58; CL, 1.07 to 2.34); length of stay or = 72 hours. Factors associated with readmission for jaundice were gestation or = 40 weeks; jaundice during nursery stay (OR, 7.80; CL, 3.38 to 18.0); length of stay or = 72 hours; male sex (OR, 2.89; CL, 1.46 to 5.74); and breastfeeding (OR, 4.21; CL, 1.80 to 9.87). Infants whose length of stay was or = 48 hours to < 72 hours. Discharge at any time < 72 hours significantly increases the risk for readmission to hospital and the risk for readmission with hyperbilirubinemia when compared with discharge after 72 hours. The American Academy of Pediatrics recommends that infants discharged < 48 hours should be seen by a health care professional within 2 to 3 days of discharge. Our observations, as well as those of others, suggest that this recommendation should also be extended to those discharged at < 72 hours after birth. One approach to decreasing the risk of morbidity and readmission, particularly from hyperbilirubinemia, would be to help mothers to nurse their infants more effectively from the moment of birth.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Journal
                avpp
                Archivos Venezolanos de Puericultura y Pediatría
                Arch Venez Puer Ped
                Sociedad Venezolana de Puericultura y Pediatría (Caracas )
                0004-0649
                June 2007
                : 70
                : 2
                : 39-46
                Affiliations
                [1 ] Hospital Universitario Dr. Alfredo Van Grieken Venezuela
                [2 ] Hospital Universitario Dr. Alfredo Van Grieken Venezuela
                [3 ] Hospital Universitario Dr. Alfredo Van Grieken Venezuela
                Article
                S0004-06492007000200002
                4b6e99f4-61ce-4f0d-9d40-654d70f03ffc

                http://creativecommons.org/licenses/by/4.0/

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                SciELO Venezuela

                Self URI (journal page): http://www.scielo.org.ve/scielo.php?script=sci_serial&pid=0004-0649&lng=en
                Categories
                HEALTH CARE SCIENCES & SERVICES
                HEALTH POLICY & SERVICES
                PEDIATRICS

                Pediatrics,Health & Social care,Public health
                newborn,Neonato,ictericia,bilirrubinometría transcutánea,jaundice,transcutaneous bilirubinometry

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