Related Experiment Video
Updated: Dec 26, 2025
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Clinical predictive score of predischarge screening for severe hyperbilirubinemia in late preterm and term infants
1Neonatology Unit, Department of Pediatrics, Maharat Nakhon Ratchasima Hospital, 49 Changpueak Road, Mueang Nakhon Ratchasima, 30000, Thailand.
Insights
A new clinical score using gestational age and transcutaneous bilirubin (TcB) levels can predict severe hyperbilirubinemia in healthy Thai newborns. This tool helps identify infants needing closer outpatient follow-up to prevent complications.
Area of Science:
- Neonatal Medicine
- Pediatrics
- Public Health
Background:
- Severe hyperbilirubinemia in newborns can lead to serious complications if not identified early.
- Effective identification and follow-up of at-risk infants are crucial for preventing adverse outcomes.
Purpose of the Study:
- To develop a clinical predictive score for identifying healthy Thai infants at risk of developing severe hyperbilirubinemia.
- To aid in early intervention and appropriate follow-up strategies.
Main Methods:
- A case-control study involving 147 hyperbilirubinemia cases and 147 controls among Thai newborns.
- Collected predischarge data included transcutaneous bilirubin (TcB) at 48-54 hours and gestational age.
- Utilized multivariable logistic regression to build a predictive model.
Main Results:
- Gestational age and predischarge TcB levels at 48-54 hours were key predictors.
- The developed risk score demonstrated an Area Under the Receiver Operating Characteristic (AuROC) curve of 81.0% for predicting severe hyperbilirubinemia.
- The score effectively stratified infants into high, moderate, and low-risk groups.
Conclusions:
- A simple predischarge score combining gestational age and TcB values effectively predicts severe hyperbilirubinemia in late preterm and term infants.
- This score can assist in identifying high-risk newborns for targeted outpatient follow-up.
- The developed tool supports proactive management of neonatal jaundice.
Background:
Early identification and appropriate follow-up of infants at risk of severe hyperbilirubinemia are part of preventing complications. This study aims to develop the clinical predictive score to predict subsequent severe hyperbilirubinemia in healthy Thai infants.
Methods:
A case-control study was conducted using medical records of 147 hyperbilirubinemia cases and 147 age-matched controls among healthy late preterm and term Thai newborn infants during January 2015 and December 2016. The routinely measured TcB values at 48-54 hours of age and all predischarge clinical characteristics were collected. Multivariable logistic regression was used to find a clinical prediction model to predict subsequent severe hyperbilirubinemia within 7 days after birth which defined as a postdischarge bilirubin level exceeding the hour-specific recommended threshold for phototherapy by the American Academy of Pediatrics (AAP).
Results:
The best clinical predictors for subsequent severe hyperbilirubinemia were TcB values at 48-54 hours and gestational age of infants. Predischarge TcB at 48-54 hours of life was classified into 3 levels: < 10 mg/dL, 10-12 mg/dL and > 12 mg/dL. Gestational age was categorized into 5 groups. The risk score derived from these 2 significant factors predicted subsequent severe hyperbilirubinemia with an AuROC curve of 81.0% (95% CI: 76.2-85.9%) in 3 risk group, high, moderate and low. The positive likelihood ratio for subsequent severe hyperbilirubinemia of the high-risk group (score > 5) was 4.53 (95% CI: 2.91-7.04) with specificity of 87.1%. The negative predictive value of low-risk group (score < 3) was 81%.
Conclusions:
A simple predischarge prediction score using gestational age and TcB values at 48-54 hours of life was developed. This score classified late preterm and term newborn infants into 3 distinct risk levels and may be useful to identify high-risk infants for outpatient follow-up of subsequent severe hyperbilirubinemia.
Related Concept Videos
01:13Sensitivity, Specificity, and Predicted Value
Sensitivity is the...
01:22Effect of Hepatic Disease on Pharmacokinetics: Pathophysiologic Assessment and Liver Function Test