Predischarge Risk Assessment for Severe Neonatal Hyperbilirubinemia

Current approaches to identifying infants at risk of developing severe neonatal hyperbilirubinemia include use of an hour-specific bilirubin nomogram that employs predischarge bilirubin measurements and clinical risk factor assessment that employs multiple factors in clinical prediction rules. Determining the hour-specific total serum bilirubin before discharge has been shown to be the most accurate method for assessing risk of severe hyperbilirubinemia. Combining clinical risk factors and predischarge bilirubin values may offer additional predictive performance above either approach used alone. Current risk assessment strategies need to be validated prospectively in a large and diverse newborn population, and the risk assessment strategies should be paired with recommended actions. Finally, transcutaneous bilirubin and end-tidal carbon monoxide measurements and screening for specific genetic markers of neonatal hyperbilirubinemia have the potential to refine risk assessment strategies further.