title: Prospective validation of a novel strategy for assessing risk of significant hyperbilirubinemia.
abstract: OBJECTIVE
  Our aim was to validate a strategy for assessing the risk of significant hyperbilirubinemia in newborns with gestational ages of ≥35 weeks by combining predischarge bilirubin percentile data with gestational age data, for a European, predominantly white population.
  
  
  METHODS
  We conducted a prospective cohort study with 463 newborns with gestational ages of ≥35 weeks who were admitted to the well-infant nursery. Total bilirubin levels were measured daily until discharge and once after discharge, between the third and eighth days of life, by using a Bilicheck device (Respironics, Murrysville, PA). The values obtained (<52 hours) were plotted on an hour-specific bilirubin nomogram to determine the infant's bilirubin percentile, expressed as a risk zone. Patients were assigned to 1 of 3 risk groups (very low, low, or high) on the basis of a combination of risk zone and gestational age data and were monitored prospectively for the development of significant hyperbilirubinemia. The 95% confidence interval (CI) for the prevalence of significant hyperbilirubinemia was estimated with the binomial distribution method.
  
  
  RESULTS
  Forty-four infants (11%) developed significant neonatal hyperbilirubinemia. The risks of developing significant hyperbilirubinemia were 1.3% (95% CI: 0.2%-3.7%) for the very low risk group (n = 230 [58.1%]), 3.4% (95% CI: 0.7%-9.8%) for the low risk group (n = 86 [21.7%]), and 47.50% (95% CI: 36.2%-59.0%) for the high risk group (n = 80 [20.20%]).
  
  
  CONCLUSIONS
  The proposed strategy, based on predischarge bilirubin level and gestational age data, was a valid method for significant hyperbilirubinemia risk assessment in our population.
authors.affiliation: Division of General Pediatrics, Pediatrics Department, Hospital São João, Porto, Portugal. americo_goncalves@hotmail.com
authors.forename: Américo
authors.initials: A
authors.lastname: Gonçalves
authors.forename: Sandra
authors.initials: S
authors.lastname: Costa
authors.forename: Andreia
authors.initials: A
authors.lastname: Lopes
authors.forename: Gustavo
authors.initials: G
authors.lastname: Rocha
authors.forename: Maria Beatriz
authors.initials: MB
authors.lastname: Guedes
authors.forename: Maria José
authors.initials: MJ
authors.lastname: Centeno
authors.forename: Jorge
authors.initials: J
authors.lastname: Silva
authors.forename: Maria Gorett
authors.initials: MG
authors.lastname: Silva
authors.forename: Milton
authors.initials: M
authors.lastname: Severo
authors.forename: Hercília
authors.initials: H
authors.lastname: Guimarães
mesh_terms: D001663:Bilirubin / Q000097:blood; D005260:Female; D006801:Humans; D006932:Hyperbilirubinemia / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology; D007231:Infant, Newborn; D008297:Male; D011446:Prospective Studies; D018570:Risk Assessment
chemical_list: D001663:Bilirubin