Transcutaneous bilirubin nomogram for evaluating the risk of hyperbilirubinemia in Iranian healthy newborns
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ORIGINAL ARTICLE
Transcutaneous bilirubin nomogram for evaluating the risk of hyperbilirubinemia in Iranian healthy newborns Robabe Seyedi1 · Mojgan Mirghafourvand2,4 · Abdollah Jannat Dost3 · Sakineh Mohammad‑Alizadeh‑Charandabi4 · Mohammad Asghari Jafarabadi5 · Shirin Osouli Tabrizi1 Received: 26 June 2018 / Accepted: 6 November 2018 © Children’s Hospital, Zhejiang University School of Medicine 2018
Abstract Background Hyperbilirubinemia, which is mostly benign, is one of the most common problems in neonates. This study was conducted to draw a skin bilirubin nomogram for evaluating the risk of hyperbilirubinemia requiring treatment. Methods This cross-sectional study recruited 1066 healthy infants. The first transcutaneous bilirubin (TcB) measurement was performed before hospital discharge and within 12–48 h of birth. The neonates were followed up for 6 days after discharge based on their age at the time of discharge. The neonates were divided into four groups based on the TcB values before discharge and age in hours, including the low-risk, medium–low-risk, medium–high-risk and high-risk groups. The percentage of neonates who progressed toward severe hyperbilirubinemia was then calculated in each percentile based on the follow-up TcB measurement. Stata software was used to draw the nomogram. Based on the TcB values at discharge and the neonate’s age in hours, the skin bilirubin nomogram was drawn in 40, 75 and 95 percentiles. Results A total of 4.9% of the neonates were in the high-risk group, 18.9% in the medium–high-risk group, 34.8% in the medium–low-risk group and 41.2% in the low-risk group. The risk of severe jaundice in the follow-up of the neonates in the highest-risk to the lowest-risk groups was 48.9, 14.5, 9.7 and 3.3%, respectively. Conclusion The skin bilirubin nomogram can be used to predict severe hyperbilirubinemia in Iranian infants. Keywords Hyperbilirubinemia · Iran · Newborn · Nomogram · Transcutaneous bilirubin
Introduction Hyperbilirubinemia is a common neonatal problem and cause of concern for parents and caregivers [1, 2]. Jaundice is the most common cause of infants’ hospitalization * Mojgan Mirghafourvand [email protected] 1
Department of Midwifery, Students Research Committee, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
2
Social Determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
3
Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
4
Midwifery Department, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Shariati‑e‑jonobi Street, Tabriz 347‑51745, Iran
5
Road Traffic Injury Research Center, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
in the first month after birth. More than half of the term infants and four-fifth of premature infants who are otherwise healthy develop a degree of jaundice 2–5 days after birth [3]. Jaundice is transient and self-limiting in most cases, but if it is severe and no
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