Objective: To plot a hour-specific transcutaneous bilirubin (TCB) nomogram for healthy neonates, and to evaluate its value for prediction of the risk of neonatal hyperbilirubinemia.
Methods: A total of 5,250 healthy full-term or near-term neonates (gestational age≥35 weeks, birth weight≥2 000 g) were enrolled as subjects. Their TCB values were continuously recorded for 168 hours after birth. The TCB values in the high-risk zones of three time periods, 24-48, 49-72, and 73-96 hours after birth, were used as predictors. The hour-specific TCB nomogram combined with the receiver operating characteristic (ROC) curve was used to evaluate the predictive value of hour-specific TCB nomogram for hyperbilirubinemia.
Results: According to the hour-specific TCB nomogram, the TCB value dramatically increased during 16-72 hours after birth, and the increase slowed down gradually during 72-144 hours. Finally, the curve reached a plateau after 144 hours. Particularly, the P95 of TCB had been stabilized at 96 hours. The P40, P75, and P95 peak values of TCB were 173, 217, and 248 µmol/L, respectively. For the prediction of hyperbilirubinemia, the areas under the ROC curve of TCB at 24-48, 49-72, and 73-96 hours after birth were 0.77, 0.85, and 0.87, respectively. The high-risk zones at 24-48, 49-72, and 73-96 hours after birth predicted the incidence rates of neonatal hyperbilirubinemia as 35.03%, 43.35%, and 79.95%, respectively, with positive likelihood ratios of 3.35, 4.75, and 22.70, respectively.
Conclusions: The hour-specific TCB nomogram and the division of TCB risk zones can give a satisfactory prediction of the incidence of neonatal hyperbilirubinemia. The neonate with a bilirubin level in the high-risk zone within 73-96 hours after birth is likely to have hyperbilirubinemia after 73-96 hours.
目的: 绘制健康新生儿小时经皮胆红素(TCB)百分位列线图, 评价其在预测高胆红素血症发生风险中的价值。
方法: 选取5 250名足月儿或晚期早产儿(胎龄≥ 35周, 出生体重≥ 2 000 g), 连续记录生后168 h TCB值。将生后24~48 h、49~72 h和73~96 h内对应最高危区TCB值作为预测指标, 采用小时TCB列线图结合受试者工作特征曲线(ROC曲线)评价小时TCB列线图对高胆红素血症的预测价值。
结果: 小时TCB百分位列线图显示, 生后16~72 h TCB快速上升明显, 72 h后至144 h上升逐渐减缓, 144 h后维持一个平稳高值, 其中第95百分位(P95)小时胆红素在96 h已趋于稳定。P40、P75、P95小时TCB高峰值分别为173、217、248 μmol/L。生后24~48 h、49~72 h和73~96 h内TCB水平预测高胆红素血症ROC曲线下面积(AUC)分别为0.77、0.85和0.87。24~48 h、49~72 h和73~96 h内高危区预测新生儿高胆红素血症患病率分别为35.03%、43.35%和79.95%, 阳性似然比分别为3.35、4.75和22.70。
结论: 小时TCB百分位列线图结合TCB值危险区的划分可较好预测新生儿高胆红素血症的发生。73~96 h内小时胆红素若处于高危区, 73~96 h后有较大可能发生高胆红素血症。