A comparison of different risk assessment models for predicting postdischarge phototherapy requirement in term and late preterm neonates

Objective:This study was conducted to compare the Bhutani nomogram and the difference between the total serum bilirubin measurement at discharge and the AAP phototherapy threshold at the time of measurement (Δ-TSB) for predicting the postdischarge bilirubin level that will exceed the phototherapy threshold. Study Design: Healthy neonates born at ≥35 weeks of gestation, followed in the newborn nursery, who did not receive phototherapy during hospital stay after birth and followed-up in the outpatient clinic at least for 1 month from 2019 to 2024 were included in the study. Four logistic models were compared (Δ-TSB, Δ-TSB-plus which encompassed additional variables as gestational age, delivery type, blood incompatibility and DAT positivity, the Bhutani risk zones and Bhutani-plus which encompassed additional variables as gestational age, delivery type, blood incompatibility) to predict postdiscsharge phototherapy requirement. Results: Of the 2040 neonates included in the study, 208 were readmitted for phototherapy treatment after discharge. ABO and/or Rh incompatibility, Bhutani risk zone, lower gestational age, being born vaginally increased the need for phototherapy. Δ-TSB was the strongest predictor of postdischarge phototherapy requirement (p<10⁻⁵⁰). Among the logistic models, Δ-TSB -plus model had the highest predictive power (AUC:0.83), followed by Δ-TSB alone (AUC:0.82), Bhutani-plus (AUC:0.80) and bhutani alone (AUC: 0.74) models, respectively. Conclusion: Δ-TSB models had higher predictive ability regarding postdischarge phototherapy requirement compared to Bhutani models. Combining Bhutani risk zones with risk factors, especially with gestational age, increased the discrimination but did not reach the success of Δ-TSB models.

Publication History

Received: 31 March 2025

Accepted after revision: 19 May 2025

Accepted Manuscript online:
20 May 2025