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Predicting the Need for Phototherapy After Discharge
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| Zeitschriftentitel: | Pediatrics |
|---|---|
| Personen und Körperschaften: | , , , , , |
| In: | Pediatrics, 147, 2021, 5 |
| Format: | E-Article |
| Sprache: | Englisch |
| veröffentlicht: |
American Academy of Pediatrics (AAP)
|
| Schlagwörter: |
| author_facet |
Kuzniewicz, Michael W. Park, Jina Niki, Hamid Walsh, Eileen M. McCulloch, Charles E. Newman, Thomas B. Kuzniewicz, Michael W. Park, Jina Niki, Hamid Walsh, Eileen M. McCulloch, Charles E. Newman, Thomas B. |
|---|---|
| author |
Kuzniewicz, Michael W. Park, Jina Niki, Hamid Walsh, Eileen M. McCulloch, Charles E. Newman, Thomas B. |
| spellingShingle |
Kuzniewicz, Michael W. Park, Jina Niki, Hamid Walsh, Eileen M. McCulloch, Charles E. Newman, Thomas B. Pediatrics Predicting the Need for Phototherapy After Discharge Pediatrics, Perinatology and Child Health |
| author_sort |
kuzniewicz, michael w. |
| spelling |
Kuzniewicz, Michael W. Park, Jina Niki, Hamid Walsh, Eileen M. McCulloch, Charles E. Newman, Thomas B. 0031-4005 1098-4275 American Academy of Pediatrics (AAP) Pediatrics, Perinatology and Child Health http://dx.doi.org/10.1542/peds.2020-019778 <jats:sec> <jats:title /> </jats:sec> <jats:sec> <jats:title>BACKGROUND AND OBJECTIVES:</jats:title> <jats:p>Bilirubin screening before discharge is performed to identify neonates at risk for future hyperbilirubinemia. The American Academy of Pediatrics recommends using a graph of bilirubin levels by age (the Bhutani Nomogram) to guide follow-up and a different graph to determine phototherapy recommendations. Our objective was to evaluate predictive models that incorporate the difference between the last total serum bilirubin (TSB) before discharge and the American Academy of Pediatrics phototherapy threshold (Δ-TSB) to predict a postdischarge TSB above the phototherapy threshold by using a single graph.</jats:p> </jats:sec> <jats:sec> <jats:title>METHODS:</jats:title> <jats:p>We studied 148 162 infants born at ≥35 weeks’ gestation at 11 Kaiser Permanente Northern California facilities from 2012 to 2017 whose TSB did not exceed phototherapy levels and who did not receive phototherapy during the birth hospitalization. We compared 3 logistic models (Δ-TSB; Δ-TSB-Plus, which included additional variables; and the Bhutani Nomogram) by using the area under the receiver operating characteristic curve (AUC) in a 20% validation subset.</jats:p> </jats:sec> <jats:sec> <jats:title>RESULTS:</jats:title> <jats:p>A total of 2623 infants (1.8%) exceeded the phototherapy threshold postdischarge. The predicted probability of exceeding the phototherapy threshold after discharge ranged from 56% for a predischarge Δ-TSB 0 to 1 mg/dL below the threshold to 0.008% for Δ-TSB &gt;7 mg/dL below the threshold. Discrimination was better for the Δ-TSB model (AUC 0.93) and the Δ-TSB-Plus model (AUC 0.95) than for the Bhutani Nomogram (AUC 0.88).</jats:p> </jats:sec> <jats:sec> <jats:title>CONCLUSIONS:</jats:title> <jats:p>The use of Δ-TSB models had excellent ability to predict postdischarge TSB above phototherapy thresholds and may be simpler to use than the Bhutani Nomogram.</jats:p> </jats:sec> Predicting the Need for Phototherapy After Discharge Pediatrics |
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10.1542/peds.2020-019778 |
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American Academy of Pediatrics (AAP), 2021 |
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American Academy of Pediatrics (AAP), 2021 |
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0031-4005 1098-4275 |
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| title |
Predicting the Need for Phototherapy After Discharge |
| title_unstemmed |
Predicting the Need for Phototherapy After Discharge |
| title_full |
Predicting the Need for Phototherapy After Discharge |
| title_fullStr |
Predicting the Need for Phototherapy After Discharge |
| title_full_unstemmed |
Predicting the Need for Phototherapy After Discharge |
| title_short |
Predicting the Need for Phototherapy After Discharge |
| title_sort |
predicting the need for phototherapy after discharge |
| topic |
Pediatrics, Perinatology and Child Health |
| url |
http://dx.doi.org/10.1542/peds.2020-019778 |
| publishDate |
2021 |
| physical |
|
| description |
<jats:sec>
<jats:title />
</jats:sec>
<jats:sec>
<jats:title>BACKGROUND AND OBJECTIVES:</jats:title>
<jats:p>Bilirubin screening before discharge is performed to identify neonates at risk for future hyperbilirubinemia. The American Academy of Pediatrics recommends using a graph of bilirubin levels by age (the Bhutani Nomogram) to guide follow-up and a different graph to determine phototherapy recommendations. Our objective was to evaluate predictive models that incorporate the difference between the last total serum bilirubin (TSB) before discharge and the American Academy of Pediatrics phototherapy threshold (Δ-TSB) to predict a postdischarge TSB above the phototherapy threshold by using a single graph.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>METHODS:</jats:title>
<jats:p>We studied 148 162 infants born at ≥35 weeks’ gestation at 11 Kaiser Permanente Northern California facilities from 2012 to 2017 whose TSB did not exceed phototherapy levels and who did not receive phototherapy during the birth hospitalization. We compared 3 logistic models (Δ-TSB; Δ-TSB-Plus, which included additional variables; and the Bhutani Nomogram) by using the area under the receiver operating characteristic curve (AUC) in a 20% validation subset.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>RESULTS:</jats:title>
<jats:p>A total of 2623 infants (1.8%) exceeded the phototherapy threshold postdischarge. The predicted probability of exceeding the phototherapy threshold after discharge ranged from 56% for a predischarge Δ-TSB 0 to 1 mg/dL below the threshold to 0.008% for Δ-TSB &gt;7 mg/dL below the threshold. Discrimination was better for the Δ-TSB model (AUC 0.93) and the Δ-TSB-Plus model (AUC 0.95) than for the Bhutani Nomogram (AUC 0.88).</jats:p>
</jats:sec>
<jats:sec>
<jats:title>CONCLUSIONS:</jats:title>
<jats:p>The use of Δ-TSB models had excellent ability to predict postdischarge TSB above phototherapy thresholds and may be simpler to use than the Bhutani Nomogram.</jats:p>
</jats:sec> |
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| author | Kuzniewicz, Michael W., Park, Jina, Niki, Hamid, Walsh, Eileen M., McCulloch, Charles E., Newman, Thomas B. |
| author_facet | Kuzniewicz, Michael W., Park, Jina, Niki, Hamid, Walsh, Eileen M., McCulloch, Charles E., Newman, Thomas B., Kuzniewicz, Michael W., Park, Jina, Niki, Hamid, Walsh, Eileen M., McCulloch, Charles E., Newman, Thomas B. |
| author_sort | kuzniewicz, michael w. |
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| description | <jats:sec> <jats:title /> </jats:sec> <jats:sec> <jats:title>BACKGROUND AND OBJECTIVES:</jats:title> <jats:p>Bilirubin screening before discharge is performed to identify neonates at risk for future hyperbilirubinemia. The American Academy of Pediatrics recommends using a graph of bilirubin levels by age (the Bhutani Nomogram) to guide follow-up and a different graph to determine phototherapy recommendations. Our objective was to evaluate predictive models that incorporate the difference between the last total serum bilirubin (TSB) before discharge and the American Academy of Pediatrics phototherapy threshold (Δ-TSB) to predict a postdischarge TSB above the phototherapy threshold by using a single graph.</jats:p> </jats:sec> <jats:sec> <jats:title>METHODS:</jats:title> <jats:p>We studied 148 162 infants born at ≥35 weeks’ gestation at 11 Kaiser Permanente Northern California facilities from 2012 to 2017 whose TSB did not exceed phototherapy levels and who did not receive phototherapy during the birth hospitalization. We compared 3 logistic models (Δ-TSB; Δ-TSB-Plus, which included additional variables; and the Bhutani Nomogram) by using the area under the receiver operating characteristic curve (AUC) in a 20% validation subset.</jats:p> </jats:sec> <jats:sec> <jats:title>RESULTS:</jats:title> <jats:p>A total of 2623 infants (1.8%) exceeded the phototherapy threshold postdischarge. The predicted probability of exceeding the phototherapy threshold after discharge ranged from 56% for a predischarge Δ-TSB 0 to 1 mg/dL below the threshold to 0.008% for Δ-TSB &gt;7 mg/dL below the threshold. Discrimination was better for the Δ-TSB model (AUC 0.93) and the Δ-TSB-Plus model (AUC 0.95) than for the Bhutani Nomogram (AUC 0.88).</jats:p> </jats:sec> <jats:sec> <jats:title>CONCLUSIONS:</jats:title> <jats:p>The use of Δ-TSB models had excellent ability to predict postdischarge TSB above phototherapy thresholds and may be simpler to use than the Bhutani Nomogram.</jats:p> </jats:sec> |
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| imprint_str_mv | American Academy of Pediatrics (AAP), 2021 |
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| publisher | American Academy of Pediatrics (AAP) |
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| series | Pediatrics |
| source_id | 49 |
| spelling | Kuzniewicz, Michael W. Park, Jina Niki, Hamid Walsh, Eileen M. McCulloch, Charles E. Newman, Thomas B. 0031-4005 1098-4275 American Academy of Pediatrics (AAP) Pediatrics, Perinatology and Child Health http://dx.doi.org/10.1542/peds.2020-019778 <jats:sec> <jats:title /> </jats:sec> <jats:sec> <jats:title>BACKGROUND AND OBJECTIVES:</jats:title> <jats:p>Bilirubin screening before discharge is performed to identify neonates at risk for future hyperbilirubinemia. The American Academy of Pediatrics recommends using a graph of bilirubin levels by age (the Bhutani Nomogram) to guide follow-up and a different graph to determine phototherapy recommendations. Our objective was to evaluate predictive models that incorporate the difference between the last total serum bilirubin (TSB) before discharge and the American Academy of Pediatrics phototherapy threshold (Δ-TSB) to predict a postdischarge TSB above the phototherapy threshold by using a single graph.</jats:p> </jats:sec> <jats:sec> <jats:title>METHODS:</jats:title> <jats:p>We studied 148 162 infants born at ≥35 weeks’ gestation at 11 Kaiser Permanente Northern California facilities from 2012 to 2017 whose TSB did not exceed phototherapy levels and who did not receive phototherapy during the birth hospitalization. We compared 3 logistic models (Δ-TSB; Δ-TSB-Plus, which included additional variables; and the Bhutani Nomogram) by using the area under the receiver operating characteristic curve (AUC) in a 20% validation subset.</jats:p> </jats:sec> <jats:sec> <jats:title>RESULTS:</jats:title> <jats:p>A total of 2623 infants (1.8%) exceeded the phototherapy threshold postdischarge. The predicted probability of exceeding the phototherapy threshold after discharge ranged from 56% for a predischarge Δ-TSB 0 to 1 mg/dL below the threshold to 0.008% for Δ-TSB &gt;7 mg/dL below the threshold. Discrimination was better for the Δ-TSB model (AUC 0.93) and the Δ-TSB-Plus model (AUC 0.95) than for the Bhutani Nomogram (AUC 0.88).</jats:p> </jats:sec> <jats:sec> <jats:title>CONCLUSIONS:</jats:title> <jats:p>The use of Δ-TSB models had excellent ability to predict postdischarge TSB above phototherapy thresholds and may be simpler to use than the Bhutani Nomogram.</jats:p> </jats:sec> Predicting the Need for Phototherapy After Discharge Pediatrics |
| spellingShingle | Kuzniewicz, Michael W., Park, Jina, Niki, Hamid, Walsh, Eileen M., McCulloch, Charles E., Newman, Thomas B., Pediatrics, Predicting the Need for Phototherapy After Discharge, Pediatrics, Perinatology and Child Health |
| title | Predicting the Need for Phototherapy After Discharge |
| title_full | Predicting the Need for Phototherapy After Discharge |
| title_fullStr | Predicting the Need for Phototherapy After Discharge |
| title_full_unstemmed | Predicting the Need for Phototherapy After Discharge |
| title_short | Predicting the Need for Phototherapy After Discharge |
| title_sort | predicting the need for phototherapy after discharge |
| title_unstemmed | Predicting the Need for Phototherapy After Discharge |
| topic | Pediatrics, Perinatology and Child Health |
| url | http://dx.doi.org/10.1542/peds.2020-019778 |