Risk Score for Predicting Severe Hyperbilirubinemia in Infant Without Early Jaundice

 

Goal: detect neonates who will have a total serum bilirubin >= 25 mg/dL and who does not have early jaundice. Early jaundice was defined as jaundice observed before 20 hours of age, jaundice treated by phototherapy during initial hospitalization, or a total serum bilirubin recorded during the initial hospitalization (page 1142).

 

Parameters:

(1) exclusive breastfeeding (which may result in dehydration and/or poor nutrition if problems occur)

(2) family history of jaundice in a newborn (history of an affected sibling)

(3) bruising

(4) race

(5) maternal age

(6) cephalohematoma (based on ICD9 code)

(7) gender of infant

(8) gestational age in weeks

Parameter	Finding	Points
exclusive breastfeeding	no	0
	yes	6
family history	absent	0
	present	6
bruising	absent	0
	present	4
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))

 

total risk score =

= SUM(points for all 8 parameters)

 

Interpretation:

• minimum score: around -4

• maximum score: 40 or more

• The higher the score the greater the risk of a severe hyperbilirubinemia.

 

Performance:

• The occurrence of severe hyperbilirubinemia is rare.

• A score > 20 was associated with a likelihood ratio of 18, with a post-test probability of 2.2%, indicating a high rate of false positives.