Predischarge risk factors for predicting significant hyperbilirubinemia in term of infants

Abstract

Background: The objective of the study to compare the predictive ability of predischarge serum total bilirubin (STB) and clinical factors for significant hyperbilirubinemia (SHB) in newborn to observe the prediction of the hyperbilirubinemia.Methods: In the prospective study, enlist of healthy newborn infants with >35 weeks gestation, in a tertiary hospital in western India. The serum bilirubin between 36-48 hours of age and risk factors for SHB were identified before discharge. SHB was distinct as a bilirubin level that exceed or was within 1mg/dL (17µmol/L) of the hour-specific phototherapy conduct threshold recommended by American Academy of Pediatrics (AAP) guideline on the management of neonatal hyperbilirubinemia.Results: Of 505 infants, 380 infants were included in final analysis, among which 70 babies (22.5%) developed SHB. On univariate analysis STB, gestational age (GA) and percentage of weight loss were found to be predictive of SHB. On multiple logistic regressions, the prognostic ability of predischarge STB is higher than that of percentage of weight loss and GA. The predictive accurateness of predischarge (<48 hours) STB level was comparable to that of percentage of weight loss (AUC=0.88, 95% CI 0.84-0.93). However, the prediction model that combined multiple risk factors such as predischarge STB, GA and percentage of weight loss have the best accuracy for predicting SHB.Conclusions: Combination of specific clinical factors (gestational age and percentage of weight loss) with predischarge serum total bilirubin described best predicts development of considerable hyperbilirubinemia.