Page 268 - 16Neonatal Jaundice_compressed

Appendix H: Evidence tables

Bibliographic details Study type & Patient characteristics Test, Reference Standard, Results Reviewers Comments
Evidence level Threshold for a positive test

Keren R; Study Type: Infants with BW = 2000 g if Test 1: Prevalence of significant Retrospective cohort study
Retrospective cohort/ GA = 36 weeks and BW = 2500 g if Clinical risk factor score derived hyperbilirubinaemia Unselected population
Year: 2005 diagnostic study GA = 35 weeks participating in the from regression modelling using Test & Reference test described
hospital’s early discharge programme, the factors found independently 98/899 (11%) adequately
Country: Evidence Level: II and who had both pre and post- associated with significant Reference test a standard test
USA discharge TSB levels measured at the hyperbilirubinaemia. Blinding – Not reported
phase when ≥ 75% babies had both Factors associated with significant
12 the samples (n = 899) Test 2: hyperbilirubinaemia (those with P < 0.2 in
Pre-discharge TSB levels expressed univariate analysis)
Group 1: infants with post-discharge as risk zone on an hour-specific
th
TSB > 95 centile on nomogram bilirubin nomogram Increased risk
th
(n = 98, 54% males, mean BW (High risk > 95 centile, High GA < 38 weeks and ≥ 40 weeks, large for
gestational age babies, higher pre-discharge
th
th
3.4 ± 0.5 kg) intermediate risk 76 – 95 TSB risk zone, combined breast and bottle
centile, Low intermediate risk 40 feeding, maternal diabetes, vacuum
th
Group 2: infants with post-discharge th th extraction, prolonged rupture, oxytocin use
th
TSB < 95 centile on nomogram – 75 centile, Low risk 0 – 40
centile)
(n = 801, 52% males, mean BW Decreased risk
3.3 ± 0.5 kg) Reference standard: Small for gestational age, parity, caesarean
Significant Hyperbilirubinaemia section
th
Exclusion: admission and treatment in defined as TSB level > 95 centile
intensive care nursery for neonatal on hour-specific nomogram. Factors independently associated with
illness and babies requiring significant hyperbilirubinaemia from
phototherapy during birth Accuracy of Clinical risk score and multivariate regression analysis (OR with
hospitalisation. pre-discharge TSB risk zone 95% CI)
evaluated for predicting significant
hyperbilirubinaemia Birthweight: 1.5 (1.2–1.9)
GA < 38 weeks: 2.6 (1.5–4.5)
Oxytocin: 2.0 (1.2–3.4)
Vacuum delivery: 2.2 (1.5–3.6)
Exclusive breastfeeding: 2.6 (1.5–4.5)
Breast and bottle feeding: 2.3 (1.1–4.9)

Clinical risk index scoring

Birthweight: 3 points for 2501–3000 g, 6 for
3001–3500 g, 9 for 3501–4000 g, 12 for
4001–4500 g, 15 for 4501–5000 g
GA < 38 weeks: 5 points Oxytocin: 4 points
Vacuum delivery: 4 points Exclusive
breastfeeding: points
Breast and bottle feeding: 4 points

Predictive accuracy for predicting
significant hyperbilirubinaemia

207