title: A Clinical Prediction Rule for Rebound Hyperbilirubinemia Following Inpatient Phototherapy.
abstract: OBJECTIVE
  The American Academy of Pediatrics provides little guidance on when to discontinue phototherapy in newborns treated for hyperbilirubinemia. We sought to develop a prediction rule to estimate the probability of rebound hyperbilirubinemia after inpatient phototherapy.
  
  
  METHODS
  Subjects for this retrospective cohort study were infants born in 2012 to 2014 at ≥35 weeks' gestation at 16 Kaiser Permanente Northern California hospitals who received inpatient phototherapy before age 14 days. We defined rebound as the return of total serum bilirubin (TSB) to phototherapy threshold within 72 hours of phototherapy termination. We used stepwise logistic regression to select predictors of rebound hyperbilirubinemia and devised and validated a prediction score by using split sample validation.
  
  
  RESULTS
  Of the 7048 infants treated with inpatient phototherapy, 4.6% had rebound hyperbilirubinemia. Our prediction score consisted of 3 variables: gestational age <38 weeks (adjusted odds ratio [aOR] 4.7; 95% confidence interval [CI], 3.0-7.3), younger age at phototherapy initiation (aOR 0.51 per day; 95% CI, 0.38-0.68), and TSB relative to the treatment threshold at phototherapy termination (aOR 1.5 per mg/dL; 95% CI, 1.4-1.7). The model performed well with an area under the receiver operating characteristic curve of 0.89 (95% CI, 0.86-0.91) in the derivation data set and 0.88 (95% CI, 0.86-0.90) in the validation data set. Approximately 70% of infants had scores <20, which correspond to a <4% probability of rebound hyperbilirubinemia.
  
  
  CONCLUSIONS
  The risk of rebound hyperbilirubinemia can be quantified according to an infant's gestational age, age at phototherapy initiation, and TSB relative to the treatment threshold at phototherapy termination.
authors.affiliation: Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington; pearlchangmd@gmail.com.
authors.forename: Pearl W
authors.initials: PW
authors.lastname: Chang
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, California; and.|Departments of Pediatrics, and.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Kuzniewicz
authors.affiliation: Epidemiology & Biostatistics, University of California, San Francisco, California.
authors.forename: Charles E
authors.initials: CE
authors.lastname: McCulloch
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, California; and.|Departments of Pediatrics, and.|Epidemiology & Biostatistics, University of California, San Francisco, California.
authors.forename: Thomas B
authors.initials: TB
authors.lastname: Newman
mesh_terms: D000367:Age Factors; D001663:Bilirubin / Q000097:blood*; D015331:Cohort Studies; D003661:Decision Support Techniques; D005260:Female; D005865:Gestational Age; D006801:Humans; D051556:Hyperbilirubinemia, Neonatal / Q000628:therapy*; D007231:Infant, Newborn; D007567:Jaundice, Neonatal / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D010789:Phototherapy; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment
chemical_list: D001663:Bilirubin