Combining Clinical Risk Factors With Serum Bilirubin Levels to Predict Hyperbilirubinemia in Newborns

Newman, Thomas B.; Liljestrand, Petra; Escobar, Gabriel J.

doi:10.1001/archpedi.159.2.113

Cited by 92 publications

(65 citation statements)

References 31 publications

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“…However, infants born at 38 weeks' gestation were categorized as low-risk infants, 29 possibly because of observations (n = 48 patients treated for hyperbilirubinemia) of no significant difference in rates of hyperbilirubinemia between infants born at 38 to 39 weeks and infants born at $40 weeks' gestation. 30 Our study confirms several smaller (n = 73-270 patients) US studies 12,[31][32][33] documenting an impact of each decreasing week of gestation on the risk of developing severe hyperbilirubinemia. Given that infants born not only after 37 but also after 38 weeks' gestation were, in most combinations of other perinatal risk factors, found to be at moderate to high risk for hyperbilirubinemia (Figure 1), we suggest that a GA of 38 weeks should be listed as a major risk factor in coming updates of neonatal hyperbilirubinemia guidelines.…”

Section: Discussionsupporting

confidence: 84%

Predicting Nonhemolytic Neonatal Hyperbilirubinemia

et al. 2015

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Section: Discussionsupporting

confidence: 84%

Predicting Nonhemolytic Neonatal Hyperbilirubinemia

et al. 2015

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“…Comparison of the predischarge TSB risk zone to a slightly modified version of Newman's risk index (developed to predict a post-discharge TSB >20 mg dl À1 ) found that the discrimination of the TSB risk zone (c ¼ 0.79) was superior to the clinical risk factor score (c ¼ 0.69), and that neonates who subsequently develop hyperbilirubinemia have predischarge TSB values that are in higher percentiles. 19 In our study, discriminating abilities of TcB alone (c ¼ 0.72) and combined tool based on TcB and gestation at birth (c ¼ 0.75) were better than that of clinical risk factors alone (c ¼ 0.58). However, these values of c-statistics are lower than those reported by most of previous studies.…”

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confidence: 46%

Predischarge non-invasive risk assessment for prediction of significant hyperbilirubinemia in term and late preterm neonates

et al. 2011

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Objective: To evaluate efficacy of predischarge transcutaneous bilirubin (TcB) measurement and clinical risk assessment in predicting hyperbilirubinemia needing treatment.Study Design: A diagnostic test was performed in a prospective cohort study conducted at a teaching hospital in North India. Subjects included healthy neonates with a gestation period of X35 weeks or birth weight X2000 g. Maternal, neonatal and delivery risk factors for hyperbilirubinemia were prospectively collected. TcB was measured in all enrolled neonates at 24±6, 72 to 96 and 96 to 144 h of postnatal age and when indicated clinically. Neonates were followed up during hospital stay and after discharge till completion of the 7th postnatal day. The key outcome was significant hyperbilirubinemia defined as need of phototherapy on the basis of modified American Academy of Pediatrics guidelines. In neonates born at X38 weeks of gestation and in neonates born at p37 completed weeks of gestation, middle line and lower line of phototherapy thresholds were used to initiate phototherapy, respectively. Variables observed to be significantly associated with significant hyperbilirubinemia on multivariate analysis were used for construction of a clinical risk assessment tool. Predictive ability of the risk assessment tool was assessed by calculating sensitivity, specificity, positive predictive value and negative predictive value, by plotting receiver-operating characteristics curve and calculating c-statistic.Result: A total of 997 neonates (birth weight: 2627 ± 536 g, gestation: 37.8 ± 1.5 weeks) were enrolled in the study, of which 931 completed follow-up. Among enrolled neonates, 344 (34.5%) were low birth weight. Overall, a total of 199 (20%) neonates developed significant hyperbilirubinemia. On stepwise logistic regression analysis, predischarge TcB percentile and gestation were significantly found to be associated with significant hyperbilirubinemia. A risk assessment graph was constructed to predict subsequent development of significant hyperbilirubinemia. Area under curve for this risk assessment strategy was 0.75. Conclusion:A risk assessment graphical tool consisting of TcB and gestation accurately predicted subsequent need of phototherapy. Further studies are needed to validate performance of this risk assessment tool.

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“…Current literature reports that combining clinical risk factors with bilirubin levels can be useful in predicting later significant or severe hyperbilirubinemia. 29,30 The predischarge bilirubin level, expressed as a risk zone on the bilirubin nomogram and used alone or when combined with multiple clinical risk factors had similar accuracy for predicting significant hyperbilirubinemia. In one single-center study, an infant's gestational age improved the overall predictive accuracy of predischarge bilirubin risk zone.…”

Section: Screening Testsmentioning

confidence: 97%

Universal bilirubin screening for severe neonatal hyperbilirubinemia

2010

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To reduce the incidence of severe neonatal hyperbilirubinemia affecting newborns with jaundice in the United States and to prevent kernicterus, there is a need to implement proven prevention strategies for severe neonatal hyperbilirubinemia as recommended in the 2004 American Academy of Pediatrics Guidelines for newborns >35 weeks gestational age. The purpose of universal predischarge bilirubin screening is to identify infants with bilirubin levels >75th percentile for age in hours and track those with rapid rates of bilirubin rise (>0.2 mg per 100 ml per h). Early identification has been reported to predict severe hyperbilirubinemia and allow for evidence-based targeted interventions. A systems approach is likely to reduce the preventable causes of acute bilirubin encephalopathy. To do so, highest priority should be given to (i) designating extreme hyperbilirubinemia (total serum bilirubin >427 mmol l À1 or >25 mg per 100 ml) as a reportable condition by laboratories and health-care providers through public health mandates; (ii) implementation of Joint Commission's Sentinel Report for kernicterus; (iii) nursing outreach to communities for education of prospective parents; (iv) development of clinical pathways to monitor, evaluate and track infants with extreme hyperbilirubinemia; and (v) societal awareness. These efforts should be monitored by a state and national surveillance system in order to critically improve the timeliness and completeness of notifications and to allow evaluation and interventions at the policy and individual family level.

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Combining Clinical Risk Factors With Serum Bilirubin Levels to Predict Hyperbilirubinemia in Newborns

Abstract: Clinical risk factors significantly improve prediction of subsequent hyperbilirubinemia compared with early TSB levels alone, especially in those with early TSB levels above the 75th percentile.

Cited by 92 publications

References 31 publications

Predicting Nonhemolytic Neonatal Hyperbilirubinemia

Predicting Nonhemolytic Neonatal Hyperbilirubinemia

Predischarge non-invasive risk assessment for prediction of significant hyperbilirubinemia in term and late preterm neonates

Universal bilirubin screening for severe neonatal hyperbilirubinemia

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