# The application of pre-discharge delta total bilirubin to predict the need for post-discharge phototherapy in healthy neonates 35 weeks’ gestation or later

## TL;DR

This study shows that pre-discharge delta total bilirubin can predict which healthy newborns may need phototherapy after leaving the hospital.

## Contribution

The study evaluates the effectiveness of pre-discharge DeltaTB in predicting post-discharge phototherapy needs in neonates.

## Key findings

- 31 out of 150 neonates required post-discharge phototherapy.
- The high-risk group had the highest proportion of post-discharge phototherapy and more follow-up visits.
- The optimal time to measure pre-discharge bilirubin was 49–72 hours with an AUC of 0.851.

## Abstract

The American Academy of Pediatrics recommended the use of pre-discharge delta total bilirubin (DeltaTB) to determine appropriate follow-up timing.

To determine the proportion of neonates requiring post-discharge phototherapy after applying the pre-discharge DeltaTB approach, and to assess its effectiveness in predicting phototherapy needs.

This is a prospective cohort study conducted at Chiang Mai University Hospital. The pre-discharge DeltaTB, defined as the difference between the bilirubin level and the phototherapy threshold at the time of measurement. Based on pre-discharge DeltaTB (mg/dL), patients were categorized into 3 risk groups: high-risk (< 3.5), moderate risk (3.5–6.9) and low risk (> 7). Post-discharge phototherapy, pre-discharge TB, and number of follow-up were compared between the risk groups. DeltaTB levels in different age intervals were analyzed using ROC curve analysis to determine the cutoff in each interval.

Out of 150 neonates, 31 (20.6%) required post-discharge phototherapy, with 9 (6.0%) neonates were classified as requiring subthreshold phototherapy. There were 17.3%, 53.3% and 19.3% of 150 neonates categorized as high, moderate, and low risk by pre-discharge DeltaTB, respectively. The high-risk group, had the highest proportion of post-discharge phototherapy, mean pre-discharge bilirubin level and number of follow-up visits and were significantly different from other groups (P-value < 0.001). The optimal timing for measuring pre-discharge bilirubin was aged 49–72 h (AUC of 0.851).

Pre-discharge DeltaTB effectively stratified neonates by risk for post-discharge phototherapy and may guide timely follow-up to prevent severe hyperbilirubinemia, with significantly higher rates in the high-risk group.