Kaur et al developed a model for predicting significant hyperbilirubinemia in term and late preterm Indian neonates at discharge. This can help to identify neonates who may benefit from more aggressive management. The authors are from Government Medical College and Hospital in Chandigarb, India.
Patient selection: neonate >= 35 weeks gestation and/or birth weight >= 2,000 grams
Outcome: significant hyperbilirubinemia, which appears to be need for intervention
Clinical risk factors associated with significant hyperbilirubinemia in univariate analysis:
(1) primiparous mother
(2) previous sibling treated for jaundice
(3) lower gestational age
(4) low birth weight (< 2,500 grams)
(5) supplemental feeding during first 24 hours after birth)
(6) presence of bruises
(7) presence of cephalohematoma
Parameters for the predictive model:
(1) predischarge transcutaneous bilirubin in mg/dL
(2) gestational age in weeks (entered as ordinal variables in 3 categories: 35-36 weeks, 37-38 weeks, and >= 39 weeks)
X =
= (0.44 * (predischarge transcutaneous bilirubin)) + (0.55 * (ordinal value for gestational age in weeks)) - 5.15
probability of significant hyperbilirubinemia =
= 1 / (1 + EXP((-1) * X))
where:
• The actual ordinal variables for gestational age are not specifically stated. Trial and error suggests 2 for 35-36 weeks, 1 for 37-38 weeks and 0 for >= 39 weeks.
In the study population 8% of neonates discharged with a bilirubin less than the 40th percentile developed significant hyperbilirubinemia, so all neonates need to be followed.
