In March 2017, Chang et al. (10.1542/peds.2016-2896) introduced us to a clinical prediction rule for predicting the probability of rebound hyperbilirubinemia that involved gestational age, age when phototherapy is initiated, and total serum bilirubin (TSB) relative to the treatment threshold at termination of phototherapy. While that rule seems fairly simple, this week Chang et al. (10.1542/peds.2018-3712) are back with an even simpler rule for predicting rebound—that involves stopping phototherapy at 2 md/dL below the threshold for treatment initiation combined with the gestational age. They applied this rule to 7,048 infants receiving phototherapy and found that only 4.6% had rebound hyperbilirubinemia. They found that the rebound probability was 2.5% when phototherapy was stopped at 2 mg/dL below the starting threshold for infants at 38 weeks or higher and was 10.2% for infants less than 38 weeks of age. The area under a receiver operating characteristic curve as 0.876 suggesting that these 2 variable models was one worth paying attention to, although younger gestational infants may need to be under the lights longer because of their higher risk of rebound.
If you are using the 3-component rule, we suspect you will want to shift to the 2-component rule after shining the light (and not just bili-lights) on this interesting study.