Background UK (NICE) guidelines recommend that bilirubin is monitored in all jaundiced babies. We implemented a home based integrated care pathway to monitor healthy term jaundiced neonates with transcutaneous bilirubinometers (TcB). Babies were readmitted to hospital for phototherapy at total serum bilirubin (TsB) ≥340µmol/l. TcB ≤ 250µmol/l correlates highly with TsB.
Aim To determine the TcB values in term babies monitored at home that could predict TsB values ≥340µmol/l.
Methods Healthy jaundiced neonates were monitored at home using Bilichek® (Ver 6.12) bilirubinometer. Babies with TcB > 250µmol/l had TsB measured using the Beckman Coulter timed endpoint diazo method within 4 hours to confirm result. We carried out statistical analysis of the paired samples to determine the TcB value with the best predictive value for TsB ≥ 340µmol/l.
Results Eighty-three paired samples were analysed from 63 babies. 6 (7%) had TsB values of ≥ 340µmol/l. The Receiver Operating Characteristics (ROC) curve analysis suggested an area under the curve (AUC) of 0.9037. TcB values ≥ 315µmol/l predicted TsB≥340 µmol/l with sensitivity of 0.83 (0.36, 1.00); specificity of 0.82 (0.71, 0.90); positive predictive value of 0.26 (0.09, 0.51) and overall accuracy of 0.82 (0.72, 0.90). TcB values ≥ 303µmol/l predictive ability had a sensitivity of 1.00 (0.54, 1.00); specificity of 0.71 (0.60, 0.81), positive predictive value of 0.21 (0.08, 0.41) and overall accuracy 0.73 (0.63, 0.83).
Conclusion Bilichek® TcB of 303µmol/l had higher sensitivity but lower specificity than TcB of 315µmol/l for predicting TsB values ≥ 340µmol/l in healthy term jaundiced neonates monitored at home.
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