Abstract | OBJECTIVE: To determine the usefulness of the hour-specific Bhutani et al bilirubin nomogram when applied to infants with Coombs-positive test results. DESIGN: Retrospective chart review. SETTING: Term nursery and neonatal intensive care unit of a university-affiliated hospital. PATIENTS: All infants with A+ or B+ blood type born in our center from September 1, 2006, through August 31, 2008, to mothers with O+ blood. OUTCOMES: Proportion of infants with Coombs-positive results from the nomogram zones who required phototherapy and comparison of the percentage of infants with Coombs-positive results in each zone with the percentage of those with Coombs-negative results in each zone. RESULTS: A total of 240 infants with Coombs-positive and 460 with Coombs-negative results having a gestational age of 35 weeks or older were evaluated. Sensitivity and specificity of data for infants with direct Coombs-positive results in zone 4 (high risk; 74.2% and 97.1%) and those for infants in zones 3 (high-intermediate risk) and 4 combined (96.7% and 83.7%) compared favorably with the data from the Bhutani et al cohort, which had direct Coombs-negative results (54.0% and 96.2% for zone 4; 90.5% and 84.7% for zones 3 and 4 combined). The likelihood ratio for infants with direct Coombs-positive results in zone 4, 25.8 (95% confidence interval, 11.4-58.4), was twice that of the Bhutani et al cohort, 14.1 (11.0-18.1). The nomogram performed well in directing the timing of bilirubin level follow-up. All infants in zones 3 and 4 with Coombs-positive results were followed up after hospital discharge. None required an exchange transfusion or developed bilirubin encephalopathy. CONCLUSIONS: The Bhutani et al bilirubin nomogram reliably identified infants at gestational age of older than 35 weeks with direct Coombs-positive results who were at risk for significant hyperbilirubinemia and directed the timing of follow-up for these infants. This finding has direct clinical applicability to the health care professional practicing in the newborn nursery.
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Authors | David L Schutzman, Romal Sekhon, Shilpa Hundalani |
Journal | Archives of pediatrics & adolescent medicine
(Arch Pediatr Adolesc Med)
Vol. 164
Issue 12
Pg. 1158-64
(Dec 2010)
ISSN: 1538-3628 [Electronic] United States |
PMID | 21135346
(Publication Type: Journal Article)
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Chemical References |
- ABO Blood-Group System
- Bilirubin
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Topics |
- ABO Blood-Group System
(blood)
- Bilirubin
(blood)
- Blood Group Incompatibility
(blood)
- Cohort Studies
- Coombs Test
- Female
- Humans
- Hyperbilirubinemia
(diagnosis)
- Infant, Newborn
- Male
- Nomograms
- Predictive Value of Tests
- Retrospective Studies
- Time Factors
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