human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background . Jaundice in near-term and term newborns is a frequent diagnosis that may prompt hospital readmission in the first postnatal week . Hyperbilirubinemia , when excessive , can lead to potentially irreversible bilirubin-induced neurotoxicity . Predischarge risk assessment ( at 24–72 hours of age ) for subsequent excessive hyperbilirubinemia is feasible by a laboratory-based assay of total serum bilirubin  ( TSB ) . Hypothesis . Noninvasive , transcutaneous , point-of-care measurement of transcutaneous bilirubin ( TcB ) predischarge by multiwavelength spectral analysis , using a portable BiliCheck device ( SpectRx Inc , Norcross , GA ) , is clinical ly equivalent to measurement of TSB in a diverse , multiracial term and near-term newborn population and predictive of subsequent hyperbilirubinemia . Methodology . We evaluated a h and -held device that uses multiwavelength spectral reflectance analysis to measure TcB ( BiliCheck ) . The study population ( 490 term and near-term newborns ) was racially diverse ( 59.1 % white , 29.5 % black , 3.46 % Hispanic , 4.48 % Asian , and 3.46 % other ) and was evaluated at 2 separate institutions using multiple ( 11 ) devices . The postnatal age ranged from 12 to 98 hours and the ranges of birth weights and gestational ages were 2000 to 5665 g and 35 to 42 weeks , respectively . All transcutaneous evaluations were performed contemporaneously and paired with a heelstick TSB measurement . All TSB assays were performed by high performance liquid chromatography , as well as by diazo dichlorophenyldiazonium tetrafluoroborate techniques . Results . TSB values ranged from .2 to 18.2 mg/dL ( mean ± st and ard deviation : 7.65 ± 3.35 mg/dL ) . The overall correlation of TSB ( by high performance liquid chromatography technique ) to TcB ( by BiliCheck devices ) was linear and statistically significant ( r = .91;r 2 = .83 ; TcB = .84 ; TSB = + .75 ; st and ard error of regression line = 1.38 ; P < .001 ; n = 490 infants ; 1788 sample s ) . Similar regression statistics were evident in subset population s categorized by race ( white : r = .91 [ n = 289 infants ] ; black : r = .91 [ n = 145 infants ] ) as well as by gestation ( term : r = .91 [ n = 1625 sample s ] ; near-term : r = .89 [ n = 163 sample s ] ) . Intradevice precision was determined to be .59 mg/dL ( 2–3 measurements per infant with 1 device ; n = 210 infants ; 510 sample s in a separate subset ) . Interdevice evaluation of 11 devices determined the precision to be .68 mg/dL ( 2–4 devices used for measurements per patient ) . In 23 of 419 of the study population infants who were in the 24- to 72-hour age range , the predischarge TSB values design ated them to be at high risk for subsequent excessive hyperbilirubinemia ( above the 95th percentile track on the hour-specific bilirubin nomogram ) . For these infants , the paired BiliCheck TcB values were all above the 75th percentile track ( negative predictive value = 100 % ; positive predictive value = 32.86 % ; sensitivity = 100 % ; specificity = 88.1 % ; likelihood ratio = 8.43 ) . Conclusions . Our data demonstrate the accuracy and reproducibility of the predischarge BiliCheck measurements in term and near-term newborn infants of diverse races and ethnicities . Infants with predischarge BiliCheck values above the 75th percentile of hour-specific TSB values on the bilirubin nomogram may be considered to be at high risk for subsequent excessive hyperbilirubinemia . Further studies are needed to assess the efficacy of this technique in preterm infants , those undergoing phototherapy , and those with TSB values of ≥15 mg/dL ( ≥256 μmol/L ) Abstract Aim : To investigate the correlation between  transcutaneous bilirubinometry ( TcB )  and total serum bilirubin ( TsB ) in jaundiced infants before and after , but not during phototherapy . Methods : This study prospect ively investigated the correlation between  TcB and TsB  in term and near term infants before and after phototherapy . Results : Overall 673 pairs of measurements ( TcB and TsB ) were performed on 371 infants of ≥35 weeks gestation and with birth weight above 2000 g. Of these 337 sets were from 200 infants who had not been treated with phototherapy ( Group 1 ) and 336 measurements from 171 infants taken between 1 h and 5 d after phototherapy ( Group 2 ) . The correlation coefficient between TcB and TsB in the whole cohort was r = 0.72 . The correlation was low during the first 8 h after phototherapy ( r = 0.56 ) , but thereafter the correlation returned to the range of 0.65–0.8 . Using the Sobel test , no significant difference was found between the correlation coefficients at the different time periods , with the possible exception of the difference between 1 and 8 h and 9 and 16 h which was of borderline significance with a p value of 0.06 . Conclusion : This study demonstrates good correlation between TcB and TsB by 8 h after phototherapy . This adds validity to community-based screening programs employing TcB measurements plotted on TsB nomograms . Such programs may contribute to prevention of tragic cases of bilirubin-induced neurologic damage A comparative pilot study was conducted to determine the difference in the reduction of total serum bilirubin in a group of infants who had phototherapy at home compared to an in-patient group on hospital phototherapy . Eighteen infants with unconjugated hyperbilirubinaemia who fitted the selection criteria were put under the mobile home unit ( Bluelite Portable Light ) placed in the home . A control group of 18 infants with the same matching characteristics had intense phototherapy in the hospital using a unit with top and bottom light sources . The infants were matched for race , starting total serum bilirubin level , birth weight ( up to 250 grams ) and age of baby at initiation of phototherapy ( up to one-day difference ) . It was observed that the mean daily decrease in serum bilirubin concentration was significantly more in the home group as compared to the hospital group ( t=2.95 , df=17 , P<0.05 ) . The mean duration of treatment was significantly less for the home group as compared to the hospital group ( t=2.84 , df=17 , P<0.05 ) . None of the infants who had home phototherapy were re-hospitalized . Phototherapy related complications were mild and comparable in both groups . The result suggests that home phototherapy is safe and effective in bringing down the concentration of serum bilirubin for term babies with uncomplicated hyperbilirubinaemia Objective : To determine the accuracy of predischarge visual assessment of jaundice for estimating bilirubin concentration and predicting risk of significant neonatal hyperbilirubinaemia . Design : Prospect i ve cohort study . Setting : Well Baby Nursery at the Hospital of the University of Pennsylvania . Patients : 522 term and late preterm newborns . Interventions : Nurses used a 5-point scale to grade the maximum cephalocaudal extent of jaundice prior to discharge . Main outcome measures : ( 1 ) Correlation between jaundice grade and bilirubin concentration . ( 2 ) Predictive accuracy of jaundice grade for identifying infants who developed significant hyperbilirubinaemia , defined as a bilirubin level that at any time after birth exceeded or was within 1 mg/dl ( 17 μmol/l ) of the American Academy of Pediatrics-recommended hour-specific phototherapy treatment threshold . Results : Nurses ’ assessment of jaundice extent was only moderately correlated with bilirubin concentration and was similar in black and non-black infants ( Spearman ’s rho = 0.45 and 0.55 , respectively ( p = 0.13 ) ) . The correlation was particularly weak among infants < 38 weeks ’ gestational age ( rho = 0.29 ) compared with infants ⩾38 weeks ’ gestation ( rho = 0.53 , p = 0.05 ) . Jaundice extent had poor overall accuracy for predicting risk of significant hyperbilirubinaemia ( c-statistic = 0.65 ) but complete absence of jaundice had high sensitivity ( 95 % ) and excellent negative predictive value ( 99 % ) for ruling out the development of significant hyperbilirubinaemia . Conclusions : Clinicians should not use extent of cephalocaudal jaundice progression to estimate bilirubin levels during the birth hospitalisation , especially in late preterm infants . However , the complete absence of jaundice can be used to predict with very high accuracy which infants will not develop significant hyperbilirubinaemia One hundred full term babies of both sexes were r and omly selected for transcutaneous bilirubin index ( TcBI ) estimation at the forehead at 12 - 24 h intervals from the time of appearance of clinical jaundice till the serum bilirubin levels fell within safe limits . TcBI was correlated with serum bilirubin estimated by conventional diazo method .  Forty babies required phototherapy , in 20 an area of 2.5 cm2 over the forehead was covered during phototherapy to make an unexposed ' window ' for TcBI estimation . The other 20 newborns received phototherapy as such and TcBI was estimated on the forehead . There was a linear relationship between serum bilirubin level and TcBI estimated at the forehead ( r = 0.9090 ; P < 0.001 ) . Further a significant linear correlation between prephototherapy and post-phototherapy ( covered and uncovered groups ) TcBI and serum bilirubin levels also existed ( r = 0.7979 ; P < 0.001 ) . There was no significant difference between post-phototherapy TcBI estimated at the covered and uncovered areas of forehead . However , post-phototherapy values of TcBI were significantly lower than corresponding prephototherapy values at higher serum bilirubin levels ( > 16 mg/dl ) OBJECTIVE In this study , we investigated prospect ively the incidence of significant hyperbilirubinemia and demographic and laboratory characteristics and pattern of  serum bilirubin levels of near-term newborns ( 35 - 37 weeks ' [ 245 - 265 days ' ] gestation ) by comparing them with those of term newborns ( 38 - 42 weeks ' [ 266 - 294 days ' ] gestation ) longitudinally in the first 7 days of life ; we also aim ed to determine the value of an early ( 6th-hour ) serum bilirubin measurement in predicting the development of significant hyperbilirubinemia later during the first week of life in near-term newborns . METHODS  Serum total bilirubin measurements  were initially made at the 6th hour of life and repeated daily for the next 4 days , and a last measurement was performed on the 7th day ( 150th hour ) in 219 term newborns ( term group ) and 146 near-term newborns ( near-term group ) . Newborns with serum total bilirubin levels of > or = 8 and > or = 12 mg/dL on day 2 , > or = 12 and > or 15 mg/dL on day 3 , and > or = 14 and > or = 17 mg/dL on days 4 , 5 , and 7 for birth weights 2000 to 2500 g and > 2500 g , respectively , were defined to have significant hyperbilirubinemia , and phototherapy treatment was started . The predictive ability of the 6th-hour serum total bilirubin value in determining the development of significant hyperbilirubinemia in the near-term group was assessed on the basis of the placement of any of the first week 's serum bilirubin measurements in the > or = 95th percentile of the study population . A Gaussian distribution curve , the 5th , 30th , 60th , and 95th percentiles , and 4 percentile tracks were obtained from mean serum total bilirubin values . On the basis of the percentile tracks with various sensitivity , specificity , and negative and positive predictive values , a nomogram demonstrating the 4 percentile tracks as risk-zone demarcators with divided risk zones was produced . RESULTS Twenty-three newborns ( 10.5 % ) in the term group and 37 newborns ( 25.3 % ) in the near-term group had significant hyperbilirubinemia and required phototherapy . When the daily mean serum bilirubin levels of the 2 groups were compared , the first 4 days ' values did not significantly differ between the 2 groups , whereas the 5th and 7th days ' values were significantly higher in the near-term group . There were significant differences between the 2 groups with respect to the incidence of significant hyperbilirubinemia , hematocrit , Apgar score , and mode of delivery . On the age-specific nomogram , the zone > 95th percentile was labeled as high risk , and that < 5th percentile was labeled as low risk . Serum total bilirubin values between the 5th and 30th , 30th and 60th , and 60th and 95th percentiles were design ated as being in the 
    Output:
    
agent
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background . Jaundice in near-term and term newborns is a frequent diagnosis that may prompt hospital readmission in the first postnatal week . Hyperbilirubinemia , when excessive , can lead to potentially irreversible bilirubin-induced neurotoxicity . Predischarge risk assessment ( at 24–72 hours of age ) for subsequent excessive hyperbilirubinemia is feasible by a laboratory-based assay of total serum bilirubin  ( TSB ) . Hypothesis . Noninvasive , transcutaneous , point-of-care measurement of transcutaneous bilirubin ( TcB ) predischarge by multiwavelength spectral analysis , using a portable BiliCheck device ( SpectRx Inc , Norcross , GA ) , is clinical ly equivalent to measurement of TSB in a diverse , multiracial term and near-term newborn population and predictive of subsequent hyperbilirubinemia . Methodology . We evaluated a h and -held device that uses multiwavelength spectral reflectance analysis to measure TcB ( BiliCheck ) . The study population ( 490 term and near-term newborns ) was racially diverse ( 59.1 % white , 29.5 % black , 3.46 % Hispanic , 4.48 % Asian , and 3.46 % other ) and was evaluated at 2 separate institutions using multiple ( 11 ) devices . The postnatal age ranged from 12 to 98 hours and the ranges of birth weights and gestational ages were 2000 to 5665 g and 35 to 42 weeks , respectively . All transcutaneous evaluations were performed contemporaneously and paired with a heelstick TSB measurement . All TSB assays were performed by high performance liquid chromatography , as well as by diazo dichlorophenyldiazonium tetrafluoroborate techniques . Results . TSB values ranged from .2 to 18.2 mg/dL ( mean ± st and ard deviation : 7.65 ± 3.35 mg/dL ) . The overall correlation of TSB ( by high performance liquid chromatography technique ) to TcB ( by BiliCheck devices ) was linear and statistically significant ( r = .91;r 2 = .83 ; TcB = .84 ; TSB = + .75 ; st and ard error of regression line = 1.38 ; P < .001 ; n = 490 infants ; 1788 sample s ) . Similar regression statistics were evident in subset population s categorized by race ( white : r = .91 [ n = 289 infants ] ; black : r = .91 [ n = 145 infants ] ) as well as by gestation ( term : r = .91 [ n = 1625 sample s ] ; near-term : r = .89 [ n = 163 sample s ] ) . Intradevice precision was determined to be .59 mg/dL ( 2–3 measurements per infant with 1 device ; n = 210 infants ; 510 sample s in a separate subset ) . Interdevice evaluation of 11 devices determined the precision to be .68 mg/dL ( 2–4 devices used for measurements per patient ) . In 23 of 419 of the study population infants who were in the 24- to 72-hour age range , the predischarge TSB values design ated them to be at high risk for subsequent excessive hyperbilirubinemia ( above the 95th percentile track on the hour-specific bilirubin nomogram ) . For these infants , the paired BiliCheck TcB values were all above the 75th percentile track ( negative predictive value = 100 % ; positive predictive value = 32.86 % ; sensitivity = 100 % ; specificity = 88.1 % ; likelihood ratio = 8.43 ) . Conclusions . Our data demonstrate the accuracy and reproducibility of the predischarge BiliCheck measurements in term and near-term newborn infants of diverse races and ethnicities . Infants with predischarge BiliCheck values above the 75th percentile of hour-specific TSB values on the bilirubin nomogram may be considered to be at high risk for subsequent excessive hyperbilirubinemia . Further studies are needed to assess the efficacy of this technique in preterm infants , those undergoing phototherapy , and those with TSB values of ≥15 mg/dL ( ≥256 μmol/L ) Abstract Aim : To investigate the correlation between  transcutaneous bilirubinometry ( TcB )  and total serum bilirubin ( TsB ) in jaundiced infants before and after , but not during phototherapy . Methods : This study prospect ively investigated the correlation between  TcB and TsB  in term and near term infants before and after phototherapy . Results : Overall 673 pairs of measurements ( TcB and TsB ) were performed on 371 infants of ≥35 weeks gestation and with birth weight above 2000 g. Of these 337 sets were from 200 infants who had not been treated with phototherapy ( Group 1 ) and 336 measurements from 171 infants taken between 1 h and 5 d after phototherapy ( Group 2 ) . The correlation coefficient between TcB and TsB in the whole cohort was r = 0.72 . The correlation was low during the first 8 h after phototherapy ( r = 0.56 ) , but thereafter the correlation returned to the range of 0.65–0.8 . Using the Sobel test , no significant difference was found between the correlation coefficients at the different time periods , with the possible exception of the difference between 1 and 8 h and 9 and 16 h which was of borderline significance with a p value of 0.06 . Conclusion : This study demonstrates good correlation between TcB and TsB by 8 h after phototherapy . This adds validity to community-based screening programs employing TcB measurements plotted on TsB nomograms . Such programs may contribute to prevention of tragic cases of bilirubin-induced neurologic damage A comparative pilot study was conducted to determine the difference in the reduction of total serum bilirubin in a group of infants who had phototherapy at home compared to an in-patient group on hospital phototherapy . Eighteen infants with unconjugated hyperbilirubinaemia who fitted the selection criteria were put under the mobile home unit ( Bluelite Portable Light ) placed in the home . A control group of 18 infants with the same matching characteristics had intense phototherapy in the hospital using a unit with top and bottom light sources . The infants were matched for race , starting total serum bilirubin level , birth weight ( up to 250 grams ) and age of baby at initiation of phototherapy ( up to one-day difference ) . It was observed that the mean daily decrease in serum bilirubin concentration was significantly more in the home group as compared to the hospital group ( t=2.95 , df=17 , P<0.05 ) . The mean duration of treatment was significantly less for the home group as compared to the hospital group ( t=2.84 , df=17 , P<0.05 ) . None of the infants who had home phototherapy were re-hospitalized . Phototherapy related complications were mild and comparable in both groups . The result suggests that home phototherapy is safe and effective in bringing down the concentration of serum bilirubin for term babies with uncomplicated hyperbilirubinaemia Objective : To determine the accuracy of predischarge visual assessment of jaundice for estimating bilirubin concentration and predicting risk of significant neonatal hyperbilirubinaemia . Design : Prospect i ve cohort study . Setting : Well Baby Nursery at the Hospital of the University of Pennsylvania . Patients : 522 term and late preterm newborns . Interventions : Nurses used a 5-point scale to grade the maximum cephalocaudal extent of jaundice prior to discharge . Main outcome measures : ( 1 ) Correlation between jaundice grade and bilirubin concentration . ( 2 ) Predictive accuracy of jaundice grade for identifying infants who developed significant hyperbilirubinaemia , defined as a bilirubin level that at any time after birth exceeded or was within 1 mg/dl ( 17 μmol/l ) of the American Academy of Pediatrics-recommended hour-specific phototherapy treatment threshold . Results : Nurses ’ assessment of jaundice extent was only moderately correlated with bilirubin concentration and was similar in black and non-black infants ( Spearman ’s rho = 0.45 and 0.55 , respectively ( p = 0.13 ) ) . The correlation was particularly weak among infants < 38 weeks ’ gestational age ( rho = 0.29 ) compared with infants ⩾38 weeks ’ gestation ( rho = 0.53 , p = 0.05 ) . Jaundice extent had poor overall accuracy for predicting risk of significant hyperbilirubinaemia ( c-statistic = 0.65 ) but complete absence of jaundice had high sensitivity ( 95 % ) and excellent negative predictive value ( 99 % ) for ruling out the development of significant hyperbilirubinaemia . Conclusions : Clinicians should not use extent of cephalocaudal jaundice progression to estimate bilirubin levels during the birth hospitalisation , especially in late preterm infants . However , the complete absence of jaundice can be used to predict with very high accuracy which infants will not develop significant hyperbilirubinaemia One hundred full term babies of both sexes were r and omly selected for transcutaneous bilirubin index ( TcBI ) estimation at the forehead at 12 - 24 h intervals from the time of appearance of clinical jaundice till the serum bilirubin levels fell within safe limits . TcBI was correlated with serum bilirubin estimated by conventional diazo method .  Forty babies required phototherapy , in 20 an area of 2.5 cm2 over the forehead was covered during phototherapy to make an unexposed ' window ' for TcBI estimation . The other 20 newborns received phototherapy as such and TcBI was estimated on the forehead . There was a linear relationship between serum bilirubin level and TcBI estimated at the forehead ( r = 0.9090 ; P < 0.001 ) . Further a significant linear correlation between prephototherapy and post-phototherapy ( covered and uncovered groups ) TcBI and serum bilirubin levels also existed ( r = 0.7979 ; P < 0.001 ) . There was no significant difference between post-phototherapy TcBI estimated at the covered and uncovered areas of forehead . However , post-phototherapy values of TcBI were significantly lower than corresponding prephototherapy values at higher serum bilirubin levels ( > 16 mg/dl ) OBJECTIVE In this study , we investigated prospect ively the incidence of significant hyperbilirubinemia and demographic and laboratory characteristics and pattern of  serum bilirubin levels of near-term newborns ( 35 - 37 weeks ' [ 245 - 265 days ' ] gestation ) by comparing them with those of term newborns ( 38 - 42 weeks ' [ 266 - 294 days ' ] gestation ) longitudinally in the first 7 days of life ; we also aim ed to determine the value of an early ( 6th-hour ) serum bilirubin measurement in predicting the development of significant hyperbilirubinemia later during the first week of life in near-term newborns . METHODS  Serum total bilirubin measurements  were initially made at the 6th hour of life and repeated daily for the next 4 days , and a last measurement was performed on the 7th day ( 150th hour ) in 219 term newborns ( term group ) and 146 near-term newborns ( near-term group ) . Newborns with serum total bilirubin levels of > or = 8 and > or = 12 mg/dL on day 2 , > or = 12 and > or 15 mg/dL on day 3 , and > or = 14 and > or = 17 mg/dL on days 4 , 5 , and 7 for birth weights 2000 to 2500 g and > 2500 g , respectively , were defined to have significant hyperbilirubinemia , and phototherapy treatment was started . The predictive ability of the 6th-hour serum total bilirubin value in determining the development of significant hyperbilirubinemia in the near-term group was assessed on the basis of the placement of any of the first week 's serum bilirubin measurements in the > or = 95th percentile of the study population . A Gaussian distribution curve , the 5th , 30th , 60th , and 95th percentiles , and 4 percentile tracks were obtained from mean serum total bilirubin values . On the basis of the percentile tracks with various sensitivity , specificity , and negative and positive predictive values , a nomogram demonstrating the 4 percentile tracks as risk-zone demarcators with divided risk zones was produced . RESULTS Twenty-three newborns ( 10.5 % ) in the term group and 37 newborns ( 25.3 % ) in the near-term group had significant hyperbilirubinemia and required phototherapy . When the daily mean serum bilirubin levels of the 2 groups were compared , the first 4 days ' values did not significantly differ between the 2 groups , whereas the 5th and 7th days ' values were significantly higher in the near-term group . There were significant differences between the 2 groups with respect to the incidence of significant hyperbilirubinemia , hematocrit , Apgar score , and mode of delivery . On the age-specific nomogram , the zone > 95th percentile was labeled as high risk , and that < 5th percentile was labeled as low risk . Serum total bilirubin values between the 5th and 30th , 30th and 60th , and 60th and 95th percentiles were design ated as being in the 
    Output:
    