An Hour-specific Nomogram for Transcutaneous Bilirubin Values in Term and Late Preterm Hispanic Neonates

ABSTRACT

We sought to determine percentile values for hour-specific transcutaneous bilirubin (TcB) measurements in Hispanic neonates during the first 72 hours of age. Neonates with gestational age ≥ 35 weeks and body weight ≥ 2100 g were included. All neonates were screened with JM-103™ TcB measurements at a minimum of every 24 hours by nursing personnel, and only TcB values obtained in Hispanic neonates with postnatal ages of 10 to 74 hours were analyzed. The 5th, 25th, 50th, 75th, and 95th percentile curves were determined. These data were compared with a previously published TcB nomogram predominantly composed of white, non-Hispanic neonates. A total of 3284 TcB values were measured in 2005 neonates. A nomogram was constructed for this exclusively Hispanic population, identifying the 5th, 25th, 50th, 75th, and 95th percentile curves. The 95th percentile values at 24, 48, and 72 hours were 7.6, 11.0, and 12.4 mg/dL, respectively. The comparison between our results and those of the previously published study indicated that small but consistent differences between the two study populations were apparent, with the Hispanic neonates having significantly higher TcB values at the majority of time points analyzed. These observations were made despite a higher proportion of neonates ≥ 40 weeks' gestation (p < 0.001) and a lower proportion exclusively breast-fed (p < 0.001) in the Hispanic population versus those in the previous study. Although higher bilirubin levels for certain populations are well documented, such differences in Hispanic neonates have not been confirmed. A TcB nomogram for Hispanic neonates is presented as a tool that will aid the clinician in the management of jaundice for this population. Compared with the previous study, this report indicates that although differences were relatively small, significantly higher TcB values were observed in the Hispanic population.

KEYWORDS

Hispanic - neonate - jaundice - transcutaneous bilirubinometry - bilirubin

REFERENCES

• 1 Gale R, Seidman D S, Dollberg S, Stevenson D K. Epidemiology of neonatal jaundice in the Jerusalem population.  J Pediatr Gastroenterol Nutr. 1990;  10 82-86
• 2 Akaba K, Kimura T, Sasaki A et al.. Neonatal hyperbilirubinemia and mutation of the uridine diphosphate-glucuronsyl transferase gene: a common missense mutation among Japanese, Koreans, and Chinese.  Biochem Mol Biol Int. 1998;  46 21-26
• 3 Lee C S, Vreman H J, Choi J H et al.. Development of jaundice in Korean neonates after Caesarean section.  Acta Paediatr Jpn. 1997;  39 309-311
• 4 Fischer A F, Nakamura H, Jetani Y, Vreman H J, Stevenson D K. Comparison in bilirubin production in Japanese and Caucasian infants.  J Pediatr Gastroenterol Nutr. 1988;  7 27-29
• 5 Munroe M, Shah C P, Badgley R, Bain H W. Birth weight, length, head circumference, and bilirubin level in Indian newborns in the Sioux Lookout Zone, northwestern Ontario.  Can Med Assoc J. 1984;  131 453-456
• 6 Johnson J D, Angelus P, Aldrich M, Skipper B J. Exaggerated jaundice in Navajo neonates: the role of bilirubin production.  Am J Dis Child. 1986;  140 889-890
• 7 Saland J, McNamara H, Cohen M I. Navajo jaundice: a variant of neonatal hyperbilirubinemia associated with breast feeding.  J Pediatr. 1974;  85 271-275
• 8 Maisels M J, Kring E. Transcutaneous bilirubin levels in the first 96 hours in a normal newborn population of ≥ 35 weeks' gestation.  Pediatrics. 2006;  117 1169-1173
• 9 Johnson C A, Liese B S, Hassanein R E. Factors predictive of heightened third-day bilirubin levels: a multiple stepwise regression analysis.  Fam Med. 1989;  21 283-287
• 10 Kaplan M, Hammerman C, Maisels M J. Bilirubin genetics for the nongeneticist: hereditary defects of neonatal bilirubin conjugation.  Pediatrics. 2003;  111 886-893
• 11 Hodgman J E, Edwards N. Racial differences in neonatal jaundice. Hyperbilirubinemia in Hispanic infants—a survey.  Clin Pediatr (Phila). 1992;  31 719-722
• 12 Bhutani V K, Gourley G R, Adler S, Kreamer B, Dalin C, Johnson L H. Noninvasive measurement of total serum bilirubin in a multiracial predischarge newborn population to assess the risk of severe hyperbilirubinemia.  Pediatrics. 2000;  106 E17
• 13 Rubaltelli F F, Gourley G R, Loskamp N et al.. Transcutaneous bilirubin measurement: a multicenter evaluation of a new device.  Pediatrics. 2001;  107 1264-1271
• 14 Maisels M J, Ostrea E M, Touch S et al.. Evaluation of a new transcutaneous bilirubinometer.  Pediatrics. 2004;  113 1628-1635
• 15 Engle W D, Jackson G L, Sendelbach D, Manning D, Frawley W H. Assessment of a transcutaneous device in the evaluation of neonatal hyperbilirubinemia in a primarily Hispanic population.  Pediatrics. 2002;  110 61-67
• 16 Kolman K B, Mathieson K M, Frias C. A comparison of transcutaneous and total serum bilirubin in newborn Hispanic infants at 35 or more weeks of gestation.  J Am Board Fam Med. 2007;  20 266-271
• 17 Engle W D, Jackson G L, Stehel E K, Sendelbach D, Manning M D. Evaluation of a transcutaneous jaundice meter following hospital discharge in term and near-term neonates.  J Perinatol. 2005;  25 486-490
• 18 De Luca D, Romagnoli C, Tiberi E, Zuppa A A, Zecca E. Skin bilirubin nomogram for the first 96h of life in a European normal healthy newborn population, obtained with multiwavelength transcutaneous bilirubinometry.  Acta Paediatr. 2008;  97 146-150
• 19 Sanpavat S, Nuchprayoon I, Smathakanee C, Hansuebsai R. Nomogram for prediction of the risk of neonatal hyperbilirubinemia, using transcutaneous bilirubin.  J Med Assoc Thai. 2005;  88 1187-1193
• 20 Ballard J L, Khoury J C, Wedig K, Wang L, Eilers-Walsman B L, Lipp R. New Ballard Score, expanded to include extremely premature infants.  J Pediatr. 1991;  119 417-423
• 21 Poland R L, Hartenberger C, McHenry H, Hsi A. Comparison of skin sites for estimating serum total bilirubin in in-patients and out-patients: chest is superior to brow.  J Perinatol. 2004;  24 541-543
• 22 Infoplease. Hispanic Americans by the Numbers. Available at http://www.infoplease.com/spot/hhmcensus1.html Accessed July 15, 2008
• 23 Sans M. Admixture studies in Latin America: from the 20th to the 21st century.  Hum Biol. 2000;  72 155-157
• 24 Bertoni B, Budowle B, Sans M, Barton S A, Chakraborty R. Admixture in Hispanics: distribution of ancestral population contributions in the continental United States.  Hum Biol. 2003;  75 1-11
• 25 Watchko J F, Daood M J, Biniwale M. Understanding neonatal hyperbilirubinaemia in the era of genomics.  Semin Neonatol. 2002;  7 143-152
• 26 Kaplan M, Hammerman C. Bilirubin and the genome: the hereditary basis of unconjugated neonatal hyperbilirubinemia.  Current Pharmacogenomics. 2005;  3 21-42
• 27 Maruo Y, Nishizawa K, Sato H, Doida Y, Shimada M. Association of neonatal hyperbilirubinemia with bilirubin UDP-glucuronosyltranserase polymorphism.  Pediatrics. 1999;  103 1224-1227
• 28 Bhutani V K, Johnson L, Sivieri E M. Predictive ability of a predischarge hour-specific serum bilirubin for subsequent significant hyperbilirubinemia in healthy term and near-term newborns.  Pediatrics. 1999;  103 6-14
• 29 American Academy of Pediatrics Sub-Committee on Hyperbilirubinemia . Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation.  Pediatrics. 2004;  114 297-316