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).
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).
Chionye Ossai, MD
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.
Vinod K. Bhutani, MD