Fractionated Bilirubin Among 252 892 Utah Newborns with and Without Biliary Atresia: A 15-year Historical Birth Cohort Study.

Autor: Kastenberg ZJ; Division of Pediatric Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT. Electronic address: zacharykastenberg@gmail.com., Deneau MR; Division of Pediatric Gastroenterology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT., O'Brien EA; Division of Neonatology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT; Intermountain Healthcare, Salt Lake City, UT., Huynh K; Intermountain Healthcare, Salt Lake City, UT., Book LS; Division of Pediatric Gastroenterology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT., Srivastava R; Intermountain Healthcare, Salt Lake City, UT; Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT., Jensen MK; Division of Pediatric Gastroenterology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT., Jaramillo CM; Division of Pediatric Gastroenterology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT., Guthery SL; Division of Pediatric Gastroenterology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT.
Jazyk: angličtina
Zdroj: The Journal of pediatrics [J Pediatr] 2023 Jun; Vol. 257, pp. 113339. Date of Electronic Publication: 2023 Jan 31.
DOI: 10.1016/j.jpeds.2022.12.041
Abstrakt: Objectives: To determine whether neonatal conjugated or direct bilirubin levels were elevated in infants with biliary atresia (BA) and to estimate the number of newborns who would have positive screens in the nursery necessitating repeat testing after discharge.
Study Design: We used administrative data from a large integrated healthcare network in Utah to identify newborns who had a fractionated bilirubin recorded during birth admission from 2005 through 2019. Elevated conjugated bilirubin was defined as greater than 0.2 mg/dL and direct bilirubin was defined as greater than 0.5 mg/dL (>97.5th percentile for the assays). We performed simulations to estimate the anticipated number of false-positive screens.
Results: There were 32 cases of BA and 468 161 live births during the study period (1/14 700). There were 252 892 newborns with fractionated bilirubin assessed, including 26 of those subsequently confirmed to have BA. Conjugated or direct bilirubin was elevated in all 26 infants with BA and an additional 3246 newborns (1.3%) without BA. Simulated data suggest 9-21 per 1000 screened newborns will have an elevated conjugated or direct bilirubin using laboratory-based thresholds for a positive screen. Screening characteristics improved with higher thresholds without increasing false-negative tests.
Conclusions: This study validates the previous findings that conjugated or direct bilirubin are elevated in the newborn period in patients with BA. A higher threshold for conjugated bilirubin improved screening performance. Future studies are warranted to determine the optimal screening test for BA and to assess the effectiveness and cost-effectiveness of implementing such a program.
(Copyright © 2023 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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