Graduation Semester and Year

2013

Language

English

Document Type

Dissertation

Degree Name

Doctor of Philosophy in Nursing

Department

Nursing

First Advisor

Judy LeFlore

Abstract

All newborns are at potential risk of adverse outcomes if they are not monitored for hyperbilirubinemia or if treatment for this problem is inadequate. Strategies are needed to accurately identify those newborns with clinically significant hyperbilirubinemia. Transcutaneous bilirubin (TcB) nomograms offer a useful screening tool to identify and monitor newborns with jaundice, as well as a way to predict the subsequent development of hyperbilirubinemia; however, there have been few studies examining the accuracy of TcB nomograms. The primary purpose of this study was to validate a previously published but unvalidated TcB nomogram to independently determine its accuracy in identifying Hispanic newborns at risk for subsequent development of significant hyperbilirubinemia (TcB > 95th percentile). A secondary analysis of an existing database was chosen to validate a TcB nomogram, and to examine dimensions relating to TcB and gestational age previously unexamined in any known study. Hour-specific TcB values from an independent sample of Hispanic newborns (n = 404) were compared with the 50th and the 75th percentile values of the nomogram at three periods of postnatal age, and then each value was examined with regard to a subsequent TcB value that represented significant hyperbilirubinemia (i.e., > 95th percentile). In each analysis, the sensitivity and NPV of the 50th and the 75th percentiles was 100% sensitivity. A secondary purpose of this study was to compare TcB values between early term and term newborns to determine if, because of their relative physiologic immaturity, early term neonates are a greater risk for hyperbilirubinemia compared to infants born after 38 weeks of gestation. Transcutaneous bilirubin values obtained at five epochs of postnatal ages in the two groups were compared. Although a significant difference in TcB values was found in one of the epochs, no significant difference was observed for the other four epochs.

Disciplines

Medicine and Health Sciences | Nursing

Comments

Degree granted by The University of Texas at Arlington

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