Predischarge Transcutaneous Bilirubin and Total Serum Bilirubin in Predicting Readmission Due to Significant Hyperbilirubinemia in Near-Term and Term Neonates

Abstract

Background: Prevention of bilirubin encephalopathy in healthy near-term and term neonates is the primary focus of newborn care. This study aims to assess the predictive accuracy of transcutaneous bilirubin (TcB) and total serum bilirubin (TSB) measured before discharge for subsequent readmission because of significant hyperbilirubinemia in near-term and term neonates during the first postnatal week and to analyze the risk factors associated with readmission because of significant hyperbilirubinemia. Methods: TcB with BiliChek device and TSB measurements with bilirubinometer were obtained prior to discharge in all healthy near-term and term neonates delivered and admitted in the postnatal wards during the study period. Postnatal age (in hours) was recorded during bilirubin measurement. Results: The predictive ability of predischarge TcB measurement for the optimum cutoff of 104 µmol/L derived from the area under the receiver operating characteristic curve has a negative predictive value of 99.3% with a negative likelihood ratio (LR) of 0.15 and sensitivity of 91.7%, whereas the predictive ability of predischarge TSB measurement for the optimum cutoff of 109 µmol/L derived from the area under the receiver operating characteristic curve has 100% sensitivity and 100% negative predictive value with a negative LR of 0.0 for no readmission because of significant hyperbilirubinemia. The predischarge TSB level of those readmitted neonates had a very high odds for high-risk zone [OR (95% CI) 358.4 (96.39, 1332.59)] and 7.8 folds higher odds for intermediate-risk zone compared to those neonates who did not require readmission in Bhutani’s predischarge nomogram. Conclusion: The result of our study showed that both TcB obtained by using BiliChek device and TSB measurements obtained by bilirubinometer for the optimum cutoffs of 104 µmol/L and 109 µmol/L, respectively, and with negative LR of 0.15 and 0.0, respectively, can be used as a safe predischarge tool for no readmission because of significant hyperbilirubinemia after 24 h of postnatal age. The existing Bhutani’s predischarge nomogram for predicting significant hyperbilirubinemia should be an additional screening tool to reduce the rate of subsequent readmission because of hyperbilirubinemia.