For nurseries that screened all/virtually all newborns with a TcB before discharge, the site representative indicated what brand of TcB device was used (Bilichek, JM-103, or both), which types of health care professional typically obtained the TcB level, and what anatomic site was used for the assessment (forehead, chest, multiple, or other). Possible responses were as follows: obtain a TSB level on virtually all newborns obtain a TcB on virtually all newborns or assess risk factors, visually check infants for jaundice, and obtain a TSB or TcB as indicated. The first item on the survey dealt with the type of screening done on all, or virtually all, newborns before discharge from the nursery. The primary aims of this analysis were to characterize differences between TcB and TSB levels among newborns undergoing routine clinical care and to identify specific patient and provider characteristics that were associated with this difference.ĭata on jaundice screening processes were first collected from BORN nursery sites by using an electronic survey. Data were collected from multiple newborn nurseries across the United States on a diverse sample of term and late preterm neonates by using different devices. 17įor the present study, we conducted a robust assessment of the accuracy of TcB measurements performed as part of routine clinical care. In a Delphi study conducted by the BORN (Better Outcomes through Research for Newborns) network to determine the research priorities of its members, the utility of TcB measurement as a screening method for jaundice in newborn infants was rated as 1 of the 10 most important topics for investigation. Clinical experience suggests that there is greater and less predictable variability of TcB levels in the “real world” than in the published studies. 16 The applicability of these results to TcB use in routine clinical settings is unclear. 3 – 15 However, in most of these previous studies, a single device was used in 1 hospital, or in a limited number of hospitals, presumably with frequent monitoring of the device’s accuracy and with optimized training of the individuals performing the TcB measurement all these conditions tend to optimize the accuracy of the measurement. Previously, investigators have found that TcB measurements have correlated well with TSB levels, with correlation coefficients ranging from ∼0.77 to 0.97. Finally, the use of TcB as an initial screen for hyperbilirubinemia, with TSB reserved for neonates with a value above some cutoff value, could potentially lead to substantial cost savings. In addition, rather than waiting for a serum bilirubin test to be performed in a laboratory, the results are virtually instantaneous. 1 It is easy to perform multiple measurements on the same newborn. 1 TcB screening is a potentially attractive modality because it is a quick, noninvasive technique to screen for hyperbilirubinemia. To promote early detection of significant hyperbilirubinemia, members of the American Academy of Pediatrics Subcommittee on Hyperbilirubinemia recommended that all newborns be screened before discharge with a total serum bilirubin (TSB) or transcutaneous bilirubin (TcB) measurement. Prevention of kernicterus in the term or late preterm neonate is a primary focus of newborn care. This study provides a “real-world” assessment of the accuracy of transcutaneous bilirubin measurements in multiple clinical settings and identification of sources of discrepancy between transcutaneous and total serum bilirubin measurements.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |