Rebound Hyperbilirubinemia Risk Score
Predicts risk of significant rebound hyperbilirubinaemia after discontinuation of phototherapy in neonates ≥35 weeks. Low-risk infants may not need post-phototherapy bilirubin checks. Identifies infants safe for early discharge after phototherapy.
Score interpretation
Low risk of significant rebound hyperbilirubinaemia
→ Check TSB 24 hours after stopping phototherapy OR use clinical judgment and parental education; if well-feeding, clinically improving, and TSB well below threshold at stop → may be safe for discharge with community midwife bilirubin check within 48 hours; advise parents on signs of worsening jaundice
Moderate rebound risk — follow-up bilirubin check required
→ Check TSB 12–18 hours after stopping phototherapy; if stable or declining, proceed with discharge plan; if rising towards threshold, restart phototherapy; breastfeeding support to ensure adequate intake; clinical assessment before discharge; midwife follow-up within 24–48 hours at home
High risk of significant rebound — close monitoring required
→ Check TSB 6–8 hours after stopping phototherapy; if haemolytic disease, check 4–6 hourly; do not discharge until bilirubin clearly declining; consider restarting phototherapy if TSB within 34 µmol/L of restart threshold; senior neonatal team review; haematology advice if haemolysis ongoing; IVIG consideration if Coombs-positive with significant haemolysis
Interpretation bands for the Rebound Bilirubin Risk. Apply clinical judgement and local guidance.
References
- Kaplan M et al. Rebound bilirubinemia in Israel: incidence and risk factors. Pediatrics. 2006;117(4):1204–1208.
- NICE NG98. Jaundice in newborn babies under 28 days. 2016 (updated 2023).
Related
Curated clinical cross-links plus same-class fallbacks.
- Rozanolixizumab · Neonatal Fc receptor (FcRn) antagonist
- Efgartigimod alfa · Neonatal Fc receptor (FcRn) blocker
- Phenobarbital (Paediatric Epilepsy — Beyond Neonatal) · Barbiturate Anticonvulsant
- Gentamicin (Paediatric) · Aminoglycoside — Neonatal Sepsis / Gram-Negative Infections in Children
- Aciclovir (Paediatric) · Antiviral — HSV Encephalitis / Neonatal Herpes / VZV in Immunocompromised
- Palivizumab · RSV Prophylaxis — Monthly Monoclonal Antibody (High-Risk Infants)
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.