Using data from this retrospective cohort study, a percentile-based
bilirubin nomogram was constructed using hour specific predischarge
and post discharge total serum bilirubin levels of 2840 healthy newborns
at Pennsylvania Hospital.
Newborn infants were included if they were tem or near term greater
than 2000g for greater than 36 weeks GA or BW greater than 2500g for
greater than 35 weeks GA and were included in the hospital supervised
Infants were excluded if they were admitted to the NICU, or had a positive
direct Coombs test. Newborns who required phototherapy <60 hrs of
life were also excluded from the predictive nomogram.
Newborns were stratified to high risk (greater than 95% for age in hours),
high-intermediate (between 75-95% for age in hours), low-intermediate
(between 40-75% for age in hours) or low risk (less than 40% for age
in hours) zones based on their hour specific TSB level.
High risk was >8 at 24 hours, >14 at 48 hours, >17 at 72 hours.
Study patients with predischarge bilirubin levels in the high risk zones
were more likely to have post discharge bilirubin levels in the high
risk zones. (LR=14.08)
Newborns with predischarge serum bilirubin levels in the intermediate
risk zone were more likely to move into the high risk zone post discharge
if they were in the higher intermediate group verses the lower intermediate
group. (LR 3.2, and 0.48 respectively)
Study patients with predischarge bilirubin levels in the low risk zones
were not likely to move into the high risk zone post discharge. (LR=
Based on the nomogram's predictive ability, newborns with predischarge
TSB levels in high and high intermediate risk zones could be followed
closely post discharge to facilitate early targeted interventions.
Newborns in the low-risk zone could safely be managed by routine pediatrician
follow-up with visual inspection.