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

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