Evaluation of the first day transcutaneous bilirubin (TcB) level as a predictor of hyperbilirubinemia in healthy term neonates

Background: The readmission rate for neonatal jaundice has been increased in recent years. This has been attributed to shorter length of postpartum hospital stays without comprehensive follow-up. The purpose of this study was to determine the diagnostic value of pre-discharge transcutaneous bilirubin (TcB) levels for prediction of subsequent hyperbilirubinemia in healthy term neonates. Methods: Between October and December 2013, a total of 99 healthy term neonates born at the Babol Clinic Hospital of healthy mother were enrolled in a prospective cross sectional study. The TcB levels were measured in all enrolled neonates between 12 and 24 hours of age just before discharge. All newborns were followed-up for jaundice to 10th day. Newborns with clinical jaundice were recalled and their serum bilirubin levels were measured. Appropriate treatment was performed based on the Amirkola Children's Hospital Protocol. TcB levels were compared between the non-treatment and treatment groups. Results: The mean age of the TcB measuring was 17.5±2.6 hours. A total of 18.1% neonates (18 of 99) were developed severe hyperbilirubinemia (need for treatment). The mean of cutaneous bilirubin level in the non-treatment and treatment groups was 5.2±1.6mg/dl and 6.3±0.9 mg/dl, respectively. The cutaneous bilirubin level at cut-off 6 mg/dl was associated with 80.0% sensitivity and 63.0% specificity. The negative predictive value was 94.6%. Conclusion: Single TcB measurements at the first 24 hours predict hyperbilirubinemia with a reasonably high degree of accuracy.