부산대학교 도서관

Background: Newborn babies can be evaluated and assessed for risk for severe hyperbilirubinemia prior to discharge and effectively targeted for follow-up and interventional strategies (Pediatrics, 1999). Objective: To develop practical and physician-friendly tools for hospital and office based application of the bilirubin nomogram. Methods: Healthy babies, both term and near-term (N-Term, [is less than or equal to] 37 weeks, 36 weeks with BW [is greater than] 2000 g, and 35 weeks with BW [is greater than] 2500 g), had a pre-discharge total serum bilirubin (TSB) test and were also evaluated for known epidemiologic and clinical risk factors for excessive hyperbilirubinemia. Babies were assigned to percentile based risk tracts on their pre-discharge TSB values = high ([is greater than] 95th percentile zone), intermediate (40 to 75th percentile zone) and low ([is less than] 40th percentile). Results: Percent of babies in each risk zone were compared for known risk groups: breast-fed (BF), N-Term, vacuum/forceps (assisted) vaginal delivery (AVD), gender, ancestry, as well as ABO ([+ or -] Coombs) sensitization. Risk Status Term Term Term N-Term ABO (BF) (AVD) Total (n) (1624) (827) (232) (326) (553) >95th %lie 3.9 3.9 5.2 4.9 9.9%(*) 40-95th %ile 53.4 60.5 59.1 59.9 42.1% >40th %ile 42.7 35.6 35.7 35.2 49.0% These data described distribution of risk status for babies based on their epidemiologic/clinical risk factors. As anticipated, a significant shift in risk pattern (p [is less than] 0.01) was seen for the ABO population, and a trend for increased risk distribution is evident for the AVD and near term population. These singled them out for closer follow-up. With the use of a software based program, predischarge coupled with hour-specific TSB values, when expressed in percentiles or visually tracked on the nomogram, facilitated risk assessment by indicating rate of rise and upward or downward change in percentile track. Thus, the impact of epidemiologic and clinical factors may be individualized for each baby. Direct reporting of TSB data from laboratories as percentile values (actual percentile or in quintiles) is also possible. Conclusion: Individualized care and risk assessment for each baby can be achieved in a practical and efficient manner by reporting TSB as hour-specific percentile values, so that they can be tracked by a busy pediatrician's office for safe, efficient, targeted management. VK Bhutani, MD, FAAP, LH Johnson. MD, FAAP, EM Sivieri, MS; Newborn Pediatrics, PA Hospital, Department of Pediatrics, University of PA, Phila, PA3
VK Bhutani, MD, FAAP, LH Johnson. MD, FAAP, EM Sivieri, MS; Newborn Pediatrics, PA Hospital, Department of Pediatrics, University of PA, Phila, [...]