title: Development and validation of serum bilirubin nomogram to predict the absence of risk for severe hyperbilirubinaemia before discharge: a prospective, multicenter study.
abstract: BACKGROUND
  Early discharge of healthy late preterm and full term newborn infants has become common practice because of the current social and economic necessities. Severe jaundice, and even kernicterus, has developed in some term infants discharged early. This study was designed to elaborate a percentile-based hour specific total serum bilirubin (TSB) nomogram and to assess its ability to predict the absence of risk for subsequent non physiologic severe hyperbilirubinaemia before discharge.
  
  
  METHODS
  A percentile-based hour-specific nomogram for TSB values was performed using TSB data of 1708 healthy full term neonates. The nomogram's predictive ability was then prospectively assessed in five different first level neonatal units, using a single TSB value determined before discharge.
  
  
  RESULTS
  The 75 th percentile of hour specific TSB nomogram allows to predict newborn babies without significant hyperbilirubinemia only after the first 72 hours of life. In the first 48 hours of life the observation of false negative results did not permit a safe discharge from the hospital.
  
  
  CONCLUSIONS
  The hour-specific TSB nomogram is able to predict all neonates without risk of non physiologic hyperbilirubinemia only after 48 to 72 hours of life. The combination of TSB determination and risk factors for hyperbilirubinemia could facilitate a safe discharge from the hospital and a targeted intervention and follow-up.
authors.affiliation: Department of Pediatrics, Catholic University of the Sacred Heart, Rome, Rome.
authors.forename: Costantino
authors.initials: C
authors.lastname: Romagnoli
authors.forename: Eloisa
authors.initials: E
authors.lastname: Tiberi
authors.forename: Giovanni
authors.initials: G
authors.lastname: Barone
authors.forename: Mario De
authors.initials: MD
authors.lastname: Curtis
authors.forename: Daniela
authors.initials: D
authors.lastname: Regoli
authors.forename: Piermichele
authors.initials: P
authors.lastname: Paolillo
authors.forename: Simonetta
authors.initials: S
authors.lastname: Picone
authors.forename: Stefano
authors.initials: S
authors.lastname: Anania
authors.forename: Maurizio
authors.initials: M
authors.lastname: Finocchi
authors.forename: Valentina
authors.initials: V
authors.lastname: Cardiello
authors.forename: Lucia
authors.initials: L
authors.lastname: Giordano
authors.forename: Valentina
authors.initials: V
authors.lastname: Paolucci
authors.forename: Enrico
authors.initials: E
authors.lastname: Zecca
mesh_terms: D001663:Bilirubin / Q000097:blood*; D005260:Female; D006801:Humans; D006932:Hyperbilirubinemia / Q000453:epidemiology*; D007231:Infant, Newborn; D008297:Male; D049451:Nomograms; D010351:Patient Discharge; D011446:Prospective Studies; D012372:ROC Curve; D012307:Risk Factors; D012680:Sensitivity and Specificity
chemical_list: D001663:Bilirubin