Development and validation of serum bilirubin nomogram to predict the absence of risk for severe hyperbilirubinaemia before discharge: a prospective, multicenter study

A percentile-based hour-specific nomogram for TSB values was performed using TSB data of 1708 healthy full term neonates. The nomogram's predictive ability was then prospectively assessed in five different first level neonatal units, using a single TSB value determined before discharge.The 75 th percentile of hour specific TSB nomogram allows to predict newborn babies without significant hyperbilirubinemia only after the first 72 hours of life. In the first 48 hours of life the observation of false negative results did not permit a safe discharge from the hospital.The hour-specific TSB nomogram is able to predict all neonates without risk of non physiologic hyperbilirubinemia only after 48 to 72 hours of life. The combination of TSB determination and risk factors for hyperbilirubinemia could facilitate a safe discharge from the hospital and a targeted intervention and follow-up.Early discharge of healthy late preterm and full term newborn infants has become common practice because of the current social and economic necessities [1-3].The association between early discharge and the need for readmission has been frequently reported, mainly because of unexpected severe hyperbilirubinemia [1,4,5].In fact, severe jaundice and even kernicterus has developed in some term infants discharged early [6-8]. For these reasons the detection of infants without risk of severe hyperbilirubinemia has become one of the most intriguing challenges for neonatologists. However, the ability of physicians and other health care providers to recognize clinically significant jaundice and predict bilirubin levels based on the cephalocaudal progression of jaundice is limited [9-12]. Total serum bilirubin (TSB) or Transcutaneous bilirubin (TcB) determination is often the only way to avoid such difficulty but the reliability of a single TSB/TcB value to identify newborn infants at risk of significant hyperbilirubinemia is not univocally accepted [13-18]. Moreover, some authors suggested caution in