Close monitoring of transcutaneous bilirubin ensures better outcome in neonates with hyperbilirubinemia

Objective To explore the influence of regular measurement of transcutaneous bilirubin (TcB) on clinical outcome of neonatal hyperbilirubinemia. Methods Healthy term and late-preterm newborns (gestational age ≥35 weeks) born between January 1 and December 31, 2013 at Peking University Third Hospital were reviewed retrospectively. All neonates were divided into monitoring group (n=1 071) or control group (n=2 437) according to whether regular monitoring of TcB was performed. General clinical information and TcB levels on admission were recorded. The incidence of hyperbilirubinemia and readmission for hyperbilirubinemia, level of bilirubin and length of hospital stay were compared between the two groups. Chi-square test or independent sample t test were used for statistical analysis. Results (1) The incidence of hyperbilirubinemia and readmission rate for hyperbilirubinemia were lower in monitoring group when compared with control group [4.7% (50/1 071) vs 7.1% (172/2 437) and 1.3% (14/1 071) vs 3.3% (81/2 437) respectively, P 0.05). (2) Of all the 222 hyperbilirubinemia patients, the number of neonates with gestational age 38 weeks was 26 (11.7%), 33(14.9%) and 163(73.4%), respectively. There was no significant difference of gestational age, birth weight and gender proportion between the two groups. (3) The follow-up rate in January was 41.5% (49/118), and the mean follow-up rate in February, April, July and October (with revised follow-up methods) was 83.1% (345/415), higher than that in January (χ2=82.505, P<0.01). (4) The first three causes of hyperbilirubinemia in all 222 patients were early-onset breast milk jaundice (72 cases, 32.4%), perinatal causes (60 cases, 27.0%) and unknown reasons (50 cases, 22.5%). The first three causes of hyperbilirubinemia in monitoring group (50 cases) were unknown reasons (24 cases, 48.0%), early-onset breast milk jaundice (14 cases, 28.0%) and hemolysis (9 cases, 18.0%). Those in the control group (172 cases) were early-onset breast milk jaundice (58 cases, 33.7%), perinatal causes (57 cases, 33.1%) and unknown reasons (26 cases, 15.1%). Conclusions Regular monitoring of TcB can reduce the incidence of hyperbilirubinemia and the readmission for hyperbilirubinemia. Key words: Hyperbilirubinemia, neonatal; Jaundice, neonatal; Bilirubin