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Risk Model of Keren et al for Predicting Neonatal Hyperbilirubinemia

Purpose: To evaluate a neonate for the risk of significant hyperbilirubinemia using the risk model of Keren et al.

Description

Keren et al identified risk factors for a neonate developing significant hyperbilirubinemia. This can help identify an infant who may benefit from closer monitoring. The authors are from Children's Hospital of Philadelphia, University of Pennsylvania, the Lucile Packard Children's Hospital, and Stanford University.


Parameters:

(1) gestational age in weeks

(2) total bilirubin at discharge, as percentile of the normal distribution

 

Gestational Age in Weeks

Total Bilirubin as Percentile

Risk

< 38 weeks

< 75th percentile

low

 

75th to 95th percentile

high

 

> 95th percentile

(very) high

38 to 39 6/7 weeks

< 75th percentile

very low

 

75th to 95th percentile

low

 

> 95th percentile

high

>= 40 weeks

< 75th percentile

very low

 

75th to 95th percentile

very low

 

> 95th percentile

high

 

where:

• The reference range for bilirubin shows a normal distribution. The percentile includes the lower tail.

• The 75th percentile corresponds to a z score of 0.67 (0.67 SD above mean)

• The 95th percentile corresponds to a z score of 1.65 (1.67 SD above the mean)

• The probability of significant hyperbilirubinemia with very low risk is 0.2 (0 to 1% in Figure 4).

• The probability of significant hyperbilirubinemia with low risk is 4 (4 to 5% in Figure 4).

• The probability of significant hyperbilirubinemia with high risk is 42 (31 to 100% of neonates affected in Figure 4; < 38 weeks and total bilirubin > 95th percentile is 100% while others are 31-52%).


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Specialty

Objective

ICD-10