Abstract
Routine bilirubin screening prior to newborn hospital discharge, using an hour-specific bilirubin nomogram, has been advocated to assess risk for subsequent severe hyperbilirubinemia. However, the false-negative rate has never been adequately studied. Our objective was to determine false-negative results of pre-discharge bilirubin screening. After routine pre-discharge, bilirubin screening was in place for over 4 years, we performed a retrospective chart review to identify infants readmitted for total bilirubin levels > 17 mg/dl (>290.7 μmol/l). We documented each infant's pre-discharge bilirubin level, risk-zone assignment by nomogram, the presence or absence of risk factors for severe hyperbilirubinemia, co-morbidities upon readmission, treatment received, and ultimate disposition. Readmitted infants whose pre-discharge bilirubin was in the low-risk (<40th percentile) and low-intermediate (40–75th percentile) risk zones of the nomogram, were considered false-negatives. Of the 6,220 infants discharged from the newborn nursery during the 51-month study period, 28 (0.45%) were readmitted for treatment of serum bilirubin levels > 17 mg/dl (>290.7 μmol/l). All received phototherapy and none required exchange transfusion. Pre-discharge bilirubin values were <40th percentile (low-risk zone) in one infant (3.6%), and between 40–75th percentiles (low-intermediate risk zone) in twelve infants (43%). Risk factors for the development of severe hyperbilirubinemia were present in 27 (96%) readmitted infants. In conclusion, nearly half of readmitted infants had pre-discharge bilirubin values in zones considered at lower risk. The use of pre-discharge bilirubin screening alone to assign future risk for severe hyperbilirubinemia may provide false reassurance. Rigorous research is required to determine the test characteristics of pre-discharge bilirubin screening before widespread acceptance and implementation. Universal early post-discharge follow-up should remain the cornerstone of preventing severe hyperbilirubinemia.
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Abbreviations
- TSB:
-
total serum bilirubin
- TCB:
-
transcutaneous bilirubin
- G6PD:
-
glucose-6-phosphate dehydrogenase deficiency
- AAP:
-
American Academy of Pediatrics
- PDB:
-
pre-discharge bilirubin
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Acknowledgment
The authors would like to thank Pat Wagstaff RN, MHA (Outcome Manager, MUSC Center for Clinical Effectiveness and Patient Safety) for her assistance in searching the patient billing database.
Ethical standards
This study was reviewed and approved by the Institutional Review Board (IRB) of the Medical University of South Carolina and has been performed in accordance with the ethical standards laid down by the 1964 Declaration of Helsinki. All details that might disclose the identity of patients has been removed. As the study was retrospective, no subjects were contacted by the research team and informed consent was waived by the IRB.
Competing interests
The authors declare that they have no conflict of interest.
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This study was unfunded.
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Slaughter, J., Annibale, D. & Suresh, G. False-negative results of pre-discharge neonatal bilirubin screening to predict severe hyperbilirubinemia: a need for caution. Eur J Pediatr 168, 1461–1466 (2009). https://doi.org/10.1007/s00431-009-0950-z
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DOI: https://doi.org/10.1007/s00431-009-0950-z