title: Model to predict hyperbilirubinemia in healthy term and near-term newborns with exclusive breast feeding.
abstract: BACKGROUND
  The aim of this study was to identify high-risk newborns who will subsequently develop significant hyperbilirubinemia Days 4 to 10 of life by using the clinical data from the first three days of life.
  
  
  METHODS
  We retrospectively collected exclusively breastfeeding healthy term and near-term newborns born in our nursery between May 1, 2002, to June 30, 2005. Clinical data, including serum bilirubin were collected and the significant predictors were identified. Bilirubin level ≥15mg/dL during Days 4 to 10 of life was defined as significant hyperbilirubinemia. A prediction model to predict subsequent hyperbilirubinemia was established. This model was externally validated in another group of newborns who were enrolled by the same criteria to test its discrimination capability.
  
  
  RESULTS
  Totally, 1979 neonates were collected and 1208 cases were excluded by our exclusion criteria. Finally, 771 newborns were enrolled and 182 (23.6%) cases developed significant hyperbilirubinemia during Days 4 to 10 of life. In the logistic regression analysis, gestational age, maximal body weight loss percentage, and peak bilirubin level during the first 72 hours of life were significantly associated with subsequent hyperbilirubinemia. A prediction model was derived with the area under receiver operating characteristic (AUROC) curve of 0.788. Model validation in the separate study (N = 209) showed similar discrimination capability (AUROC = 0.8340).
  
  
  CONCLUSIONS
  Gestational age, maximal body weight loss percentage, and peak serum bilirubin level during the first 3 days of life have highest predictive value of subsequent significant hyperbilirubinemia. We provide a good model to predict the risk of subsequent significant hyperbilirubinemia.
authors.affiliation: Department of Pediatrics, Taipei City Hospital, Heping FuYou Branch, Taipei, Taiwan.
authors.forename: Hsin-Chung
authors.initials: HC
authors.lastname: Huang
authors.forename: Hwai-I
authors.initials: HI
authors.lastname: Yang
authors.forename: Yu-Hsun
authors.initials: YH
authors.lastname: Chang
authors.forename: Rui-Jane
authors.initials: RJ
authors.lastname: Chang
authors.forename: Mei-Huei
authors.initials: MH
authors.lastname: Chen
authors.forename: Chien-Yi
authors.initials: CY
authors.lastname: Chen
authors.forename: Hung-Chieh
authors.initials: HC
authors.lastname: Chou
authors.forename: Wu-Shiun
authors.initials: WS
authors.lastname: Hsieh
authors.forename: Po-Nien
authors.initials: PN
authors.lastname: Tsao
mesh_terms: D001942:Breast Feeding; D005260:Female; D006801:Humans; D051556:Hyperbilirubinemia, Neonatal / Q000209:etiology*; D007231:Infant, Newborn; D016015:Logistic Models; D011247:Pregnancy; D012372:ROC Curve; D012189:Retrospective Studies