Predicting Significant Hyperbilirubinemia Based on the Hourly-Specific Total Serum Bilirubin Zones of Bhutani et al

Description

Bhutani et al developed curves for predicting the risk of significant hyperbilirubinemia in a newborn infant based on the total serum bilirubin level and the number of hours since birth that the serum specimen was collected. This can help identify those infants who require closer monitoring and who may benefit from aggressive management. The authors are from the Pennsylvania Hospital in Philadelphia.

Patient selection: term or near term infants from 18 to 144 hours after delivery.

	Total Serum Bilirubin in mg/dL
Hour Post Delivery	40% Curve	75% Curve	95% Curve
18	4.6	5.6	7.0
24	5.0	6.4	7.8
30	6.0	7.4	9.4
36	7.1	9.0	11.1
42	7.9	10.0	12.4
48	8.6	10.8	13.2
54	9.1	11.7	14.1
60	9.6	12.6	15.2
66	10.5	13.1	15.6
72	11.2	13.4	16.0
78	11.4	14.0	16.3
84	11.6	14.7	16.9
90	12.0	14.9	17.1
96	12.4	15.2	17.4
102	12.6	15.4	17.5
108	12.9	15.5	17.5
114	13.1	15.6	17.6
120	13.2	15.8	17.6
126	13.2	15.6	17.5
132	13.2	15.5	17.5
138	13.2	15.5	17.5
144	13.2	15.5	17.5

from Figure 2, page 9

Using JMP these can be approximated by the following equations:

total serum bilirubin defining the 40th percentile curve =

= (-0.000706 * ((hours since birth)^2)) + (0.18404 * (hours since birth)) +1.2802

total serum bilirubin defining the 75th percentile curve =

= (0.0000025 * ((hours since birth)^3)) - (0.001604 * ((hours since birth)^2)) + (0.28144 * (hours since birth)) + 0.74945

total serum bilirubin defining the 95th percentile curve =

= (0.0000071 * ((hours since birth)^3)) - (0.002915 * ((hours since birth)^2)) + (0.38946 * (hours since birth)) + 0.4643

Total Serum Bilirubin	Zone	Probability of Significant Hyperbilirubinemia
below 40th percentile curve	low risk	practically 0
from to the 40th to the 75th percentile curve	low intermediate risk	1 in 46
above the 75th to the 95th percentile curve	high intermediate risk	1 in 8
above the 95th percentile curve	high risk	2 in 5

from Table 3, page 11

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ICD-10