Twenty-four hours' transcutaneous bilirubin as a predictor of subsequent 3rd day neonatal hyperbilirubinemia

Abstract

Context: Neonatal jaundice is the most common problem that can occur in over half of full term and most premature infants. Recently, due to the upcoming trend of early discharges, it is seen that these newborns are at increased risk for hospital readmission for jaundice. Hence, this study was designed to study the association between 1st day transcutaneous bilirubin (TcB) and subsequent significant neonatal hyperbilirubinemia (NNH) and to use it as a predictor for the same. Aim: This study aims to study the value of 1st day TcB as a predictor of subsequent NNH. Settings and Design: This was a descriptive correlational study conducted on 236 newborns born in our hospital which is a tertiary care center. Subjects and Methods: Inclusion criteria: Full term normal babies, ≥2.5 kg birth weight. Exclusion criteria: Rh incompatibility, babies with life-threatening conditions. After a baby was born, TcB was taken at 24 h of life and the newborn's bilirubin values were estimated on 24, 36, 48, and 72 h of life by measuring TcB; and total serum bilirubin was estimated whenever TcB was abnormal or at 72 h. TcB at 24 h >8 mg/dl and at 72 h >16 mg/dl was taken as significant. Serum bilirubin at 72 h >17 mg/dl was taken as significant as recommended by the AAP. Statistical Analysis Used: Statistical analysis was done using descriptive and inferential statistics using Chi-square test, receiver operating characteristic (ROC) analysis and the softwares used were IBM-SPSS version 17.0, graphpad prism 5.0 version developed by graphpad software inc. California, Epi Info a public domain software developed by Centers for Disease Control and Prevention in Atlanta, Georgia (USA). P 8 mg/dl at 24 h of life has a sensitivity of 79.71% and specificity of 96.41% to detect subsequent NNH. Area under ROC curve = 0.95. Conclusions: TcB at 24 h has a very high correlation with the TcB, TSB, and thus NNH at 72 h of life with a P = 0.0001.