Kuzniewicz et al reported a modified Clinical Risk Index to evaluate neonate at risk for hyperbilirubinemia. This is based on the score of Newman et al. The authors are from the University of California San Francisco and Kaiser Permanente.
Patient selection: neonate >= 35 weeks of age with hyperbilirubinemia
Outcome: severe hyperbilirubinemia
Parameters:
(1) gestational age in weeks
(2) feeding
(3) neonatal jaundice requiring phototherapy in parent or sibling
(4) cephalohematoma or bruising
(5) race
(6) maternal age in years
(7) gender
Parameter
Finding
Points
gestational age
35 weeks
12
36 weeks
10
37 weeks
7
38 weeks
4
39 weeks
2
40 weeks
0
41 weeks
-2
42 weeks
-4
feeding
breast milk only
6
formula only
-6
both
0
neonatal jaundice in family member
no
0
yes
6
cephalohematoma or bruising
no
0
yes
4
race
not Asian
0
Asian
4
maternal age
< 25 years
0
>= 25 years
3
gender
female
0
male
1
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: -10
• maximum score: 36
• The higher the score the greater the risk of hyperbilirubinemia.
Follow-up period is based on the score and the serum total bilirubin risk group o the Bhutani nomogram
Score
Low Risk
Low-Intermediate
High-Intermediate
High Risk
< 5
NA
NA
1 to 3 days
1 day
5 to 9
NA
1 to 3 days
1 to 2 days
1 day
10 to 14
1 to 3 days
1 to 2 days
1 day
1 day
>= 15
1 to 2 days
1 day
1 day
1 day
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