Chang et al developed a clinical prediction rule for rebound hyperbilirubinemia in a neonate after inpatient phototherapy. This can help to identify a neonate who may benefit from more aggressive management. The authors are from Seattle Children's Hospital, Kaiser Permanente Northern California and University of California in San Francisco.
Patient selection: born at >= 35 weeks gestation, with inpatient phototherapy before age 14 days
Outcome: return of total serum bilirubin to phototherapy threshold within 72 hours of stopping phototherapy (occurred in 4.6% of the population)
Parameters:
(1) gestational age in weeks
(2) age at phototherapy initiation in days
(3) AAP (American Academy of Pediatrics) phototherapy threshold
(4) total serum bilirubin at termination of phototherapy in mg/dL
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Gestational Age
|
Points
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|
< 38 weeks
|
15
|
|
>= 38 weeks
|
0
|
score =
= (points for gestational age) - (7 * (age in days at initiation)) - (4 * ((AAP phototherapy threshold) - (total serum bilirubin)) + 50
Interpretation:
• minimum score: around 0
• maximum score: around 65
• The higher the score the greater the risk of rebound hyperbilirubinemia.
|
Score
|
Rebound Hyperbilirubinemia (derivation and validation groups)
|
|
<= 9
|
0.3%
|
|
10 to 19
|
1.8 to 2.8%
|
|
20 to 29
|
5 to 6%
|
|
30 to 39
|
17 to 19%
|
|
40 to 49
|
26 to 33%
|
|
>= 50
|
41 to 49%
|
Performance:
• The area under the ROC curve is 0.88.
