Page 223 - 16Neonatal Jaundice_compressed

Neonatal jaundice

Bibliographic details Study type and Patient characteristics Methodology and interventions Results Reviewers Comments
Evidence level
using Odds ratios with 95% CI, 2) Prediction of hyperbilirubinaemia
and these factors used for
modelling in predicting Prediction by Day 1 TSB only (threshold
hyperbilirubinaemia value > 85 micromol/litre)
Sensitivity: 63.1%
Specificity: 94.2%

Prediction by all model variables without
Day 1 TSB
Sensitivity: 57.9%
Specificity: 90.4%

Prediction by all model variables
Sensitivity: 81.8%
Specificity: 82.9%

Keren R et al.; Study Type: Infants managed exclusively in the 1) Factors associated with Prevalence of significant Unselected population (stratified
Prospective cohort well infants nursery of an urban significant hyperbilirubinaemia hyperbilirubinaemia sampling) with well defined exclusion
Year: 2008 study tertiary care hospital with in univariate analysis entered criteria
GA = 36 weeks and BW = 2000 g into regression modeling for Baseline characteristics of two groups not
Country: USA Evidence Level: II or GA = 35 weeks and clinical risk factor model 48/751 (6.4%) – 61 had an incomplete compared
follow-up
BW = 2500 g Confounding variables controlled
14 2) Comparison of diagnostic Methodology described adequately
n = 812 accuracy of three tests in 1) Association of factors with significant Blinding – not specified
hyperbilirubinaemia (Univariate analysis)
mean BW 3.3 ± 0.5 kg predicting significant (n = 812)
GA < 38 weeks: 13.4% hyperbilirubinaemia by the c-
statistic (mathematically equal to
Gender: males = 49.4%
Ethnicity: area under ROC curve) Factors increasing risk

White = 33.5% Test 1: Pre-discharge bilirubin –
Black = 53.2% Pre-discharge bilirubin measured high risk zone OR: 147 (95% CI 34–639)
Asian = 9.8% either by TcB or TSB at high-intermediate risk zone OR: 21
Other = 3.4%
< 52 hours of age, and expressed (95% CI 4.9–93.0)
Since the population in the area as risk-zone on hour specific GA < 38 weeks OR: 9.2 (95% CI 4.4–
nomogram.
19.0)
was predominantly black, stratified Daily TcB levels recorded using intended breastfeeding OR: 2.2 (95% CI
sampling scheme used to get a BiliChek, and TSB performed if 1.0–4.5)
representative sample.
th
Group 1: Infants with significant TcB above 75 centile on hour- intended breast + bottle feeds OR: 3.7
hyperbilirubinaemia (n = 48) specific nomogram or TcB (95% CI 1.6–8.6)
Grade 4 or higher degree of clinical
reading = 205 micromol/litre jaundice OR 6.0 (95% CI 2.1 to 17)
Group 2: Infants without TSB value taken for analysis
significant hyperbilirubinaemia when both TcB and TSB done. Factors decreasing risk
(n = 703)
Test 2: Black race OR 0.43 )95% CI 0.23–0.80)
Maternal history of smoking OR: Not
Exclusion: Clinical risk factors assessed by reported
babies transferred to the intensive review of hospital charts for
184