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Comparative Study
. 2005 Apr;90(4):415-21.
doi: 10.1136/adc.2004.060079.

Identifying newborns at risk of significant hyperbilirubinaemia: a comparison of two recommended approaches

R Keren  1 , V K Bhutani, X Luan, S Nihtianova, A Cnaan, J S Schwartz
Affiliations
Comparative Study

Identifying newborns at risk of significant hyperbilirubinaemia: a comparison of two recommended approaches

R Keren et al. Arch Dis Child. 2005 Apr.

Abstract

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.

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Figures

Figure 1
Figure 1
Assembly of study sample.
Figure 2
Figure 2
Receiver operating curves for clinical risk factor score and pre-discharge TSB risk zone.
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References

    1. Br Med J. 1973 Sep 1;3(5878):476-7 - PubMed
    1. Clin Chem. 2004 Jan;50(1):190-4 - PubMed
    1. Br Med J. 1977 Jan 8;1(6053):72-3 - PubMed
    1. Br Med J. 1977 Sep 10;2(6088):679-80 - PubMed
    1. Arch Dis Child. 1979 Feb;54(2):111-5 - PubMed

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