Newman et al used a partial risk score to identify an infant without early jaundice who is at risk for significant hyperbilirubinemia. This can help identify an infant who should undergo closer monitoring. The authors are from the University of California San Francisco, Kaiser Permanente Medical Center Oakland and Kaiser Permanente Medical Center in Walnut Creek.
Parameters used for the partial risk score (derived from score described in previous section, based on availability of data electronically):
(1) race
(2) maternal age
(3) cephalohematoma (based on ICD9 code)
(4) gender of infant
(5) gestational age
Additional factor:
(6) percentile and z-score for total serum bilirubin measured at less than 48 hours old (using postnatal age specific data)
|
Parameter |
Finding |
Points |
|
race |
Asian |
4 |
|
|
Black |
-2 |
|
|
other |
0 |
|
maternal age |
< 25 years of age |
0 |
|
|
>= 25 years of age |
3 |
|
cephalohematoma |
absent |
0 |
|
|
present |
3 |
|
gender |
female |
0 |
|
|
male |
1 |
|
gestational age |
|
2 * (40 - (GA)) |
z-score for total serum bilirubin =
= ((patient value in mg/dL) - (mean value for age in mg/dL)) / (standard deviation for age)
partial risk score =
= SUM(points for all 5 parameters)
partial risk score plus z-score =
= (partial risk score) + (z-score for total serum bilirubin)
Interpretation:
• The higher the partial risk score the greater the risk of severe hyperbilirubinemia.
|
Percentile Bilirubin |
Partial Risk Score |
Risk Total Serum Bilirubin >= 20 mg/dL |
|
< 75% |
NA |
<= 2.5% |
|
75 - 94% |
<= 3 |
1% |
|
|
4 to 6 |
3% |
|
|
7 to 10 |
6% |
|
|
>= 11 |
9% |
|
>= 95% |
<= 3 |
6% |
|
|
4 to 6 |
13% |
|
|
7 to 10 |
22% |
|
|
>= 11 |
36% |
estimated from Figure 2, page 116
Performance:
• The partial risk score had an area under the ROC curve of 0.69.
• The percentile for total serum bilirubin and the z-score had an AUC of 0.79 and 0.83 respectively.
• The combination of the partial risk score and z-score had an AUC of 0.86.
Purpose: To evaluate a newborn infant for the risk of developing a total serum bilirubin >= 20 mg/dL using the partial risk score of Newman et al.
Specialty: Pedatrics, Gastroenterology
Objective: risk factors, criteria for diagnosis, severity, prognosis, stage
ICD-10: P59, E80.7,
