Preterm birth affects about 15 million children per year worldwide; in France, 12,000 infants are born before 32 weeks' gestational age every year. 1 Despite improved survival of preterm infants, the risk of motor, sensory or cognitive disorder during childhood is high. 2Cognitive disorders such as delayed language development, attention disorder or dyspraxia are associated with lower academic performance. [3][4][5][6][7][8] In a large cohort of preterm infants born in France in 1997, a previous study estimated that 30% of children born under or at 32 weeks' gestational age had schooling difficulties. 9 Early detection of potential disorders is a public health challenge in order to offer adapted care: speech therapy, physiotherapy, psychomotricity or a special needs teaching assistant. Previous studies showed that efficacy is improved if such management is started early on, in the preschool period. 10,11 Consequently, follow-up has been standardised in France up to 6-7 years of age, with regional outpatient networks.

Background: Transcutaneous bilirubin (TcB) is a validated test for systematic screening of neonatal hyperbilirubinemia and monitoring term and near-term infants under phototherapy. Objectives: To evaluate TcB diagnostic accuracy for very preterm neonates. Methods: Total serum bilirubin (TSB) and TcB measurements were performed prospectively in a multicenter sample of newborns <30 weeks of gestational age (GA). TcB sensitivity, specificity, predictive values, and likelihood ratios for the detection of neonates requiring phototherapy were calculated over the first 15 days of life, with or without phototherapy, with the expectation of achieving a detection rate of hyperbilirubinemia of over 95%. The potential influence of neonatal characteristics on the discordance between TcB and TSB in very preterm newborns was analyzed using multivariate multilevel logistic regression analyses. Results: Altogether, 481 measurements were analyzed in 167 preterm patients. Mean GA was 27.6 ± 1.6 weeks. The rates of newborns requiring phototherapy were 52% in the first 3 days, 16% from the 4th to the 7th day, and 2% during the second week. Diagnostic performance was similar among babies with or without phototherapy. TcB sensitivity decreased over time from 100% (93.9-100.0) to 50% (1.3-98.7). Specificity showed an inverse evolution from 14.8% (7.0-26.2) to 80.7% (72.2-89.2). The best performance was that of negative predictive values which varied from 95.5 to 100.0. False negatives were rare throughout the study (0.8% of measurements). In a multivariate analysis, the only factor significantly influencing discordance between TcB and TSB was postnatal age. We did not find any impact of GA and skin color. Conclusion: Among very preterm babies, TcB measurements might be useful for screening for neonatal jaundice in the first 2 weeks of life. In case of a TcB value below the phototherapy threshold, invasive TSB quantification could be unnecessary, with potential avoidance of blood drawing.

PNA as primary therapy for SIP is a viable option, resulting in definitive treatment in 60% of cases, with limited mortality and morbidity.

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