Transcutaneous Bilirubin Nomogram for Predicting Significant Neonatal Hyperbilirubinemia at Discharge Time in Healthy Term and Near-Term Iranian Infants

Hyperbilirubinemia is one of the most common causes of neonatal re-hospitalization; using transcutaneous bilirubin (TCB) measurement nomogram, the aim of this study was to determine the risk of severe hyperbilirobinemia in term and near-term Iranian neonates at discharge time. 450 healthy newborn infants, with the gestational age of ≥ 35 weeks, weight of ≥ 2 kg, and the age of 12 to 140 hours were enrolled in this randomized-descriptive practical study. Before being discharged, the infant’s bilirubin was measured using Bilichek that was placed on their chest and between two nipples. After being discharged, the newborn infants were followed up. According to the discharge time transcutaneous bilirubin level, the infant's age (in terms of hour), and based on bilirubin nomogram, the newborns were divided into four groups of low-risk, low-medium-risk, high-medium-risk, and high-risk. In following up the infants, if they were suffering hyperbilirobinemia, the bilirubin was measured again. According to discharge time transcutaneous bilirubin level and the infant's based-on-hour age, 20% of the subjects were included in the low-risk group, 33.1% in low-medium-risk group, 32.2% in high-medium-risk group, and 14.7% in high-risk group. The risk of severe hyperbilirobinemia in followed-up newborns was 1.4%, 6.9%, 13.6%, and 32.8%, in groups 1 to 4, respectively. During this time, 11.9% of the newborns were found to have sever hyperbilirubinemia (more than 95th percentile. By providing bilirubin nomogram, based on transcutaneous bilirubin level and the infant's age (in terms of hour), the severity of future hyperbilirobinemia can be estimated in Iranian healthy newborns. The transcutaneous bilirubin method with bilichek, that is a non-invasive method, can be recommended for all newborns at discharge time.