Li Huiyi, Huang Xihua, Liang Zhenyu, Liang Haijian, He Si, Tang Li
Department of Neonatology, the Affiliated Guangdong Second Provincial General Hospital of Jinan University, Guangzhou, China.
Department of Nursing, the Affiliated Guangdong Second Provincial General Hospital of Jinan University, Guangzhou, China.
Transl Pediatr. 2024 Aug 31;13(8):1302-1311. doi: 10.21037/tp-24-21. Epub 2024 Aug 23.
Rebound hyperbilirubinemia (HBB) is still present in as high as 10% of newborn babies. However, the applicability of established prediction models for rebound HBB to Chinese newborns is unclear. This study aimed to establish a model to predict HBB rebound after phototherapy among Chinese neonates.
A retrospective cohort study was conducted on 1,035 HBB infants receiving phototherapy. Rebound HBB was defined as total serum bilirubin (TSB) returning to or above the American Academy of Pediatrics (AAP) phototherapy threshold within 72 hours after the end of phototherapy. The predictive effects of previously published two- and three-variable scores were verified. Neonates were randomly assigned in a 6:4 ratio to the training (n=621) group and the testing (n=414) group. All variables in the training set were used to select predictors by least absolute shrinkage and selection operator (LASSO) regression analysis. The internal validation of the prediction model was performed using the testing set. The model's predictive performance was evaluated by area under the curve (AUC), accuracy, sensitivity, and specificity, each with 95% confidence intervals (CIs). Receiver operating characteristic (ROC) and calibration curves were constructed to evaluate the discrimination ability and fitting effect of the prediction model, respectively.
Rebound HBB was observed in 210 patients (20.3%). The AUC for the two- and three-variable scores were 0.498 (95% CI: 0.455-0.540) and 0.498 (95% CI: 0.457-0.540), respectively. Predictive factors for the risk of rebound HBB included formula feeding (>3 times/day), standard phototherapy irradiation time, TSB levels and age at termination of phototherapy, neonatal weight, and differences between TSB levels at the phototherapy termination and phototherapy threshold. The prediction model's AUC was 0.935 (95% CI: 0.911-0.958), the sensitivity was 0.880 (95% CI: 0.809-0.950), the specificity was 0.831 (95% CI: 0.790-0.871), and the accuracy was 0.841 (95% CI: 0.805-0.876).
The established model performed well in predicting rebound risk among Chinese infants with HBB, which may be beneficial in treating and managing HBB in infants.
高达10%的新生儿仍会出现反弹性高胆红素血症（HBB）。然而，已有的反弹性HBB预测模型在中国新生儿中的适用性尚不清楚。本研究旨在建立一个模型来预测中国新生儿光疗后HBB的反弹情况。
对1035例接受光疗的HBB婴儿进行回顾性队列研究。反弹性HBB定义为光疗结束后72小时内血清总胆红素（TSB）恢复到或高于美国儿科学会（AAP）光疗阈值。验证了先前发表的二变量和三变量评分的预测效果。将新生儿按6:4的比例随机分为训练组（n = 621）和测试组（n = 414）。训练集中的所有变量用于通过最小绝对收缩和选择算子（LASSO）回归分析选择预测因子。使用测试集对预测模型进行内部验证。通过曲线下面积（AUC）、准确性、敏感性和特异性评估模型的预测性能，各指标均有95%置信区间（CIs）。构建受试者工作特征（ROC）曲线和校准曲线分别评估预测模型的区分能力和拟合效果。
210例患者（20.3%）出现反弹性HBB。二变量和三变量评分的AUC分别为0.498（95%CI：0.455 - 0.540）和0.498（95%CI：0.457 - 0.540）。反弹性HBB风险的预测因素包括配方奶喂养（>3次/天）、标准光疗照射时间、TSB水平和光疗结束时的年龄、新生儿体重以及光疗结束时TSB水平与光疗阈值之间的差异。预测模型的AUC为0.935（95%CI：0.911 - 0.958），敏感性为0.880（95%CI：0.809 - 0.950），特异性为0.831（95%CI：0.790 - 0.871），准确性为0.841（95%CI：0.805 - 0.876）。
所建立的模型在预测中国HBB婴儿的反弹风险方面表现良好，这可能有助于对婴儿HBB的治疗和管理。
