Universal Newborn Bilirubin (SB) Screening. • 1133

Abstract

Kernicterus in seemingly healthy but jaundiced term and near term newborns has reemerged in this decade. About 1-2% of the Well Baby (WB) population is at risk for SB 3 20mg/dl and about 5% for SB 3 17mg/dl; these groups are at risk for bilirubin induced neurologic dysfunction (BIND). We hypothesize 1) that Universal SB analyses at the time of the predischarge metabolic screen, when plotted on the SB nomogram shown below will predict the high risk groups and 2) use of the predictive SB nomogram will facilitate cost effective, individualized follow-up. Based upon a previously reported database of hour-specific SB values in 1097 WB, we developed this nomogram for the first week of life. At ≈ 24 hours age, SB 3 8mg/dl was at 95th percentile and the likelihood ratio for SB 3 17 was 19.4; whereas, for SB <5 (50th percentile) it was zero. For values between 5 and 8 mg/dl, the risk was less predictable presumably due to the interplay of variations in enterohepatic circulation, bruising, liver bilirubin excretion and minor infections in infants with G6PD deficiency. Implementation of a protocol for Universal SB Screening and follow-up for all WB discharges at PA Hosp. began in 1995 and has so far confirmed the predictive ability of the nomogram: No baby in the <50th percentile at discharge developed SB 3 17mg/dl; babies in the 395th percentile were again the highest risk group. Prior to widespread use, this nomogram requires validation in a very large, diverse population (comparable to US demographics) to confirm reliability of the no risk group and to clarify risk in the intermediate SB percentiles.Figure