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Vol. 90. Núm. 3.
Páginas 273-278 (Maio - Junho 2014)
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Vol. 90. Núm. 3.
Páginas 273-278 (Maio - Junho 2014)
Artigo Original
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Validation of transcutaneous bilirubin nomogram for identifying neonatal hyperbilirubinemia in healthy Chinese term and late-preterm infants: a multicenter study
Validação de um nomograma de bilirrubina transcutânea para identificação de hiperbilirrubinemia neonatal em neonatos a termo e pré-termo tardios saudáveis na China: um estudo multicêntrico
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Zhangbin Yua, Shuping Hana, Jinxia Wub, Mingxia Lic, Huaiyan Wangd, Jimei Wange, Jiebo Liuf, Xinnian Pang, Jie Yangh, Chao Cheni,
Autor para correspondência
chen6010@163.com

Corresponding author.
a Departamento de Pediatria, Nanjing Maternity and Child Health Care Hospital of Nanjin Medical University, Nanjing, China
b Departamento de Neonatologia, Inner Mongolia Maternal and Child Health Care Hospital, Huhehot, China
c Departmento de Neonatologia, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
d Departamento de Neonatologia, Changzhou Maternal and Child Health Care Hospital, Changzhou, China
e Departamento de Neonatologia, Gynecology and Obstetrics Hospital, Fudan University, Xangai, China
f Departamento de Pediatria, The Fifth People's Hospital of Shenzhen, Shenzhen, China
g Departamento de Neonatologia, Guangxi Maternal and Child Health Hospital, Nanning, China
h Departamento de Neonatologia, Guangdong Maternal and Children's Hospital, Guangzhou Medical College, Guangzhou, China
i Departamento de Neonatologia, Children's Hospital of Fudan University, Xangai, China
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Abstract
Objective

to prospectively validate a previously constructed transcutaneous bilirubin (TcB) nomogram for identifying severe hyperbilirubinemia in healthy Chinese term and late-preterm infants.

Methods

this was a multicenter study that included 9,174 healthy term and late-preterm infants in eight hospitals of China. TcB measurements were performed using a JM-103 biliru-binometer. TcB values were plotted on a previously developed TcB nomogram, to identify the predictive ability for subsequent significant hyperbilirubinemia.

Results

in the present study,972 neonates (10.6%)developedsignificant hyperbilirubinemia. The 40th percentile of the nomogram could identify all neonates who were at risk of significant hyperbilirubinemia, but with a low positive predictive value (PPV) (18.9%). Of the 453 neonatesabove the 95th percentile, 275 subsequently developed significant hyperbilirubinemia, with a high PPV (60.7%), but with low sensitivity (28.3%). The 75th percentile was highly specific (81.9%) and moderately sensitive (79.8%). The area under the curve (AUC) for the TcB nomogram was 0.875.

Conclusions

this study validated the previously developed TcB nomogram, which could be used to predict subsequent significant hyperbilirubinemia in healthy Chinese term and late-preterm infants. However, combining TcB nomogram and clinical risk factors could improve the predictive accuracy for severe hyperbilirubinemia, which was not assessed in the study. Further studies are necessary to confirm this combination.

Keywords:
Hyperbilirubinemia
Jaundice
Neonatal
Bilirubin
Newborn
Resumo
Objetivo

validar de forma prospectiva um nomograma de bilirrubina transcutânea (BTc) para identificar hiperbilirrubinemia grave em neonatos a termo e pré-termo tardios saudáveis na China.

Métodos

foi realizado um estudo multicêntrico que incluiu 9174 neonatos a termo e pré- termo tardios saudáveis em oito unidades da China. Foram realizadas dosagens de BTc utilizando um bilirrubinômetro. Os valores de BTc foram traçados em um nomograma de BTc para identificara capacidade de predição de hiperbilirrubinemia significativa.

Resultados

972 recém-nascidos (10,6%) desenvolveram hiperbilirrubinemia significativa. O percentil 40 de nosso nomograma pode identificar todos os recém-nascidos com risco de hiper-bilirrubinemia significativa, porém com baixo valor preditivo positivo (VPP) (18,9%). De 453 recém-nascidos acima do percentil 95, 275 recém-nascidos desenvolve- ram posteriormente hiperbilirrubinemia significativa, com VPP elevado (60,7%), porém com baixa sensibilidade (28,3%). O percentil de 75 foi altamente específico (81,9%) e moderadamente sensível (79,8%). A área sob a curva (ASC) de nosso nomograma de BTc foi de 0,875.

Conclusões

este estudo validou o nomograma de BTc, que pode ser utilizado para prever hiperbilirrubinemia significativa em neonatos a termo e pré-termo tardios saudáveis na China. Contudo, combinar o nomograma de BTc e fatores de risco clínicos pode melhorar a precisãode predição da hiperbilirrubinemia grave, o que não foi avaliado neste estudo. São necessários estudos adicionais para confirmar essa combinação.

Palavras-chave:
Hiperbilirrubinemia
Icterícia
Neonatal
Bilirrubina
eonatos
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Como citar este artigo:Yu Z, Han S, Wu J, Li M, Wang H, Wang J, et al. Validation of transcutaneous bilirubin nomogram for identifying neonatal hyperbilirubinemia in healthy Chinese term and late-preterm infants: a multicenter study. J Pediatr (Rio J). 2014;90:273-8.

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