Risk Factors for Severe Hyperbilirubinemia in Neonate with Elevated Serum Bilirubin

 

Total serum bilirubin indicating severe hyperbilirubinemia: >= 25 mg/dL

 

Patient selection: total serum bilirubin 17-22.9 mg/dL at age >= 48 hours

 

Parameters:

(1) gestational age

(2) bruising

(3) feeding

(4) rate of increase in the total serum bilirubin

 

Parameter	Finding	Points
gestational age	< 40 weeks	0
	>= 40 weeks	1
bruising	absent	0
	present	1
feeding	exclusively breast fed	1
	other	0
rate of increase in bilirubin	< 6 mg/dL per day	0
	>= 6 mg/dL per day	1

 

where:

• The odds ratios vary from 2.1 to 3.7. An alternative approach is to multiply the odds ratios together.

• The odds ratio for 34-37 weeks is 3.7 (vs a neonate >= 40 weeks). The odds ratio for 38-39 weeks is 3.2 (vs a neonate >= 40 weeks).

• The rate of increase in bilirubin = (change in bilirubin levels) / (interval between readings in days)

 

total number of risk factors =

= SUM(points for all 4 risk factors)

 

Interpretation:

• minimum number of risk factors: 0

• maximum number of risk factors: 4

• The more risk factors present the greater the risk for severe hyperbilirubinemia.