Prediction of Neonatal Hyperbilirubinemia
Prediction of Neonatal Hyperbilirubinemia
Objective: To develop an evidence-based strategy for assessing the risk of significant
 hyperbilirubinemia in healthy term and near-term (late-preterm) neonates.

 Hypothesis: A stepwise strategy which combines clinical parameters and serial non-invasive
 transcutaneous bilirubin (TcB) values could reliably predict significant neonatal
 hyperbilirubinemia.

 Methods: Data from neonates >34 weeks' gestation included in the registry for neonatal
 hyperbilirubinemia of the well-baby nursery of the University Hospital of Patras, from
 January 2008 to December 2010 will be reviewed.

 The registry includes prospectively collected data such as sex, gestational age, gestation
 and perinatal information, mother's and infant's ABO group and Rh, G6PD deficiency, Coombs
 test, type of delivery and complications, birthweight, postnatal medications and
 interventions, type and volume of feeding (daily), extension of jaundice, TcB measurements at
 intervals of 12+/-4 hours until discharge, total serum bilirubin values (if obtained), TcB or
 TSB measurements at follow-up, weight at discharge, need of phototherapy (inpatient or after
 discharge). TcB and TSB values are plotted on a hour-specific chart.

 A novel predictive nomogram based on TcB measurements (Varvarigou et al. Pediatrics
 2009;124:1052-9) will be used to classify TcB values as high, intermediate, and low risk.

 Significant hyperbilirubinemia will be defined as a TSB value above the phototherapy
 threshold level according to the AAP 2004 guidelines

 Statistics: Independent and joint effects of various clinical factors on the development of
 significant hyperbilirubinemia will be evaluated by logistic regression analysis Cluster
 analysis and Chi-squared Automatic Interaction Detection (CHAID) tree method will be used to
 develop the strategy. At each step, CHAID chooses the independent (predictor) variable that
 has the strongest interaction with the dependent variable. Categories of each predictor are
 merged if they are not significantly different with respect to the dependent variable.
Inclusion Criteria:

 -  Healthy term and late-preterm neonates

 Exclusion Criteria:

 -  Admission to the NICU