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Identifying newborns at risk of significant hyperbilirubinaemia: a comparison of two recommended approaches
1Division of General Pediatrics, Pediatric Generalist Research Group, The Children's Hospital of Philadelphia, PA, USA. keren@email.chop.edu
Insights
Pre-discharge bilirubin measurement is more accurate than clinical risk factors for predicting infant jaundice. This screening tool helps identify newborns at risk of significant hyperbilirubinaemia.
Area of Science:
- Neonatal care
- Pediatric endocrinology
- Clinical diagnostics
Background:
- Neonatal hyperbilirubinaemia is a common condition.
- Effective screening is crucial for preventing severe outcomes.
- Current screening methods include clinical risk factors and bilirubin measurements.
Purpose of the Study:
- To compare the predictive performance of clinical risk factor assessment and pre-discharge bilirubin measurement.
- To identify infants at risk of significant neonatal hyperbilirubinaemia (post-discharge total serum bilirubin >95th centile).
Main Methods:
- Retrospective cohort study of term and near-term infants.
- Development of a clinical risk factor scoring system.
- Comparison with pre-discharge total serum bilirubin (TSB) on a bilirubin nomogram.
- Evaluation of discrimination, sensitivity, specificity, and likelihood ratios.
Main Results:
- Pre-discharge bilirubin risk zone showed better discrimination (c = 0.83) than clinical risk score (c = 0.71).
- Bilirubin measurement predicted risk up to 59%, compared to 44% for clinical factors.
- Neither method achieved high sensitivity without compromising specificity.
Conclusions:
- Pre-discharge bilirubin measurement, expressed as a risk zone on a nomogram, is more accurate.
- This method provides wider risk stratification than clinical risk factor scores.
- It offers improved screening for significant neonatal hyperbilirubinaemia.
Aims:
To compare the predictive performance of clinical risk factor assessment and pre-discharge bilirubin measurement as screening tools for identifying infants at risk of developing significant neonatal hyperbilirubinaemia (post-discharge total serum bilirubin (TSB) >95th centile).
Methods:
Retrospective cohort study of term and near term infants born in an urban community teaching hospital in Pennsylvania (1993-97). A clinical risk factor scoring system was developed and its predictive performance compared to a pre-discharge TSB expressed as a risk zone on a bilirubin nomogram. Main outcome measures were prediction model discrimination, range of predicted probabilities, and sensitivity, specificity, positive and negative predictive values, and likelihood ratios for various positivity criteria.
Results:
The clinical risk factor scoring system developed included birth weight, gestational age <38 weeks, oxytocin use during delivery, vacuum extraction, breast feeding, and combination breast and bottle feeding. The pre-discharge bilirubin risk zone had better discrimination (c = 0.83; 95% CI 0.80 to 0.86) than the clinical risk factor score (c = 0.71; 95% CI 0.66 to 0.76) and predicted risk of significant hyperbilirubinaemia as high as 59% compared with a maximum of 44% for the clinical risk factor score. Neither the risk score nor the pre-discharge TSB risk zone predicted the outcome with > or =0.98 sensitivity without significantly compromising specificity (0.13 and 0.21, respectively). Multi-level clinical risk factor scores and TSB risk zones produced likelihood ratios of 0.15-3.25 and 0.05-9.43, respectively.
Conclusions:
The pre-discharge bilirubin expressed as a risk zone on an hour specific bilirubin nomogram is more accurate and generates wider risk stratification than a clinical risk factor score.
