Document Detail

Hour-specific bilirubin nomogram in infants with ABO incompatibility and direct Coombs-positive results.
MedLine Citation:
PMID:  21135346     Owner:  NLM     Status:  MEDLINE    
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.
David L Schutzman; Romal Sekhon; Shilpa Hundalani
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Archives of pediatrics & adolescent medicine     Volume:  164     ISSN:  1538-3628     ISO Abbreviation:  Arch Pediatr Adolesc Med     Publication Date:  2010 Dec 
Date Detail:
Created Date:  2010-12-07     Completed Date:  2011-01-10     Revised Date:  2011-03-09    
Medline Journal Info:
Nlm Unique ID:  9422751     Medline TA:  Arch Pediatr Adolesc Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1158-64     Citation Subset:  AIM; IM    
Division of Neonatology, Department of Pediatrics, Albert Einstein Medical Center, Philadelphia, PA 19141, USA.
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MeSH Terms
ABO Blood-Group System / blood*
Bilirubin / blood*
Blood Group Incompatibility / blood*
Cohort Studies
Coombs' Test*
Hyperbilirubinemia / diagnosis*
Infant, Newborn
Predictive Value of Tests
Retrospective Studies
Time Factors
Reg. No./Substance:
0/ABO Blood-Group System; 635-65-4/Bilirubin
Erratum In:
Arch Pediatr Adolesc Med. 2011 Feb;165(2):118

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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