Neonatal Hyperbilirubinemia: Recommendations for Diagnosis and Management in the Emergency Department | Calculators
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Neonatal Hyperbilirubinemia: Recommendations for Diagnosis and Management in the Emergency Department

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Hour-specific Risk for Neonatal Hyperbilirubinemia

Introduction

The Hour-specific Risk for Neonatal Hyperbilirubinemia tool predicts risk of hyperbilirubinemia in neonates.

About the Score

The American Academy of Pediatrics recommends risk assessment for the development of severe hyperbilirubinemia in every neonate. The Hour-specific Risk for Neonatal Hyperbilirubinemia tool predicts the risk of subsequent severe hyperbilirubinemia in neonates who are ≥35 weeks’ gestational age. This tool should not be used in neonates who have a positive direct Coombs test, or in neonates who require phototherapy at <60 hours of age. The tool is used at the time of discharge to help determine timing for follow-up visits, and should not be used to determine the need for exchange transfusion. Only a total serum bilirubin level should be used (ie, not direct or indirect bilirubin).

Evidence Appraisal

The hour-specific nomogram was created in 1999 following a study led by Dr. Vinod Bhutani. A percentile-based bilirubin nomogram was constructed from hour-specific predischarge and postdischarge total serum bilirubin values in newborns (n = 2840; median birth weight = 3230 g; median gestational age = 39 weeks) for the first week of life.

The study excluded newborns who had a positive direct Coombs test or who required phototherapy at <60 hours of age. The predischarge total serum bilirubin level in 61.8% of the newborns (1756/2840) was in the low-risk zone (<40th percentile), and there was no measurable risk for significant hyperbilirubinemia (likelihood ratio = 0; 100% sensitivity; 64.7% specificity; 0% probability).

Calculator Review Authors

Chionye Ossai, MD

Department of Pediatric Hospital Medicine, Cleveland Clinic, Cleveland, OH

Instructions

The Hour-specific Risk for Neonatal Hyperbilirubinemia is for use at the time of discharge in otherwise healthy neonates who are ≥35 weeks’ gestational age. It should not be used in neonates with a positive direct Coombs test, or in neonates who require phototherapy at <60 hours of age. Do not use this tool to determine the need for exchange transfusion.

The recommendations listed here for starting phototherapy are based on American Academy of Pediatrics guidelines. Always use clinical judgment, in addition to considering evidence-based clinical guidelines, in making treatment decisions.

Calculator Creator

Vinod K. Bhutani, MD

References

Original/Primary Reference

  • Bhutani VK, Johnson L, Sivieri EM. Predictive ability of a predischarge hour-specific serum bilirubin for subsequent significant hyperbilirubinemia in healthy term and near-term newborns. Pediatrics. 1999;103(1):6-14. DOI: 10.1542/peds.103.1.6

Validation Reference

  • Stevenson DK, Fanaroff AA, Maisels MJ, et al. Prediction of hyperbilirubinemia in near-term and term infants. Pediatrics. 2001;108(1):31-39. DOI: 10.1542/peds.108.1.31

Other References

  • American Academy of Pediatrics Subcommittee on Hyperbilirubinemia. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics. 2004;114(1):297-316. DOI: 10.1542/peds.114.1.297
  • Newman TB, Xiong B, Gonzales VM, et al. Prediction and prevention of extreme neonatal hyperbilirubinemia in a mature health maintenance organization. Arch Pediatr Adolesc Med. 2000;154(11):1140-1147. DOI: 10.1001/archpedi.154.11.1140
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Publication Information
Authors

Abdullah Khan, MD; Tommy Y. Kim, MD

Peer Reviewed By

Jennifer Bellis, MD, MPH; Mary Jane Piroutek, MD

Publication Date

January 2, 2022

CME Expiration Date

February 1, 2025

Pub Med ID: 34919365

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