Bilirubin Screening in Neonates
Rebecca Cook
Sara V. Bates
Predictive Ability of a Predischarge Hour-Specific Serum Bilirubin for Subsequent Significant Hyperbilirubinemia in Healthy Term and Near-Term Newborns
Bhutani VK, Johnson L, Sivieri EM. Pediatrics. 1999;103(1):6–14
Background
Extreme hyperbilirubinemia has been estimated to occur in 25:100,000 term and near-term neonates, with approximately one-third developing kernicterus, which can be associated with hearing loss, encephalopathy, and cerebral palsy.1 Neurotoxicity at time of presentation with extreme hyperbilirubinemia is more common in infants who have been discharged home. As physical examination alone is not reliable at recognizing significant neonatal jaundice, identifying newborns at high risk of developing significant hyperbilirubinemia could improve outcomes by allowing closer follow-up after discharge and appropriate treatment before progression. This study sought to use predischarge total serum bilirubin (TSB) to identify infants at low, intermediate, and high risk of significant neonatal jaundice post-discharge.
Objectives
To assess the predictive ability of a universal predischarge TSB screening to identify healthy term and near-term infants at risk for development of post-discharge significant hyperbilirubinemia.
Methods
Prospective cohort study in a single US academic center from 1993 to 1997.
Patients
2,840 term and near-term newborns with appropriate birth weight for gestational age (≥2,000 g for ≥36 weeks’ gestation and ≥2,500 g for 35 to 36 weeks’ gestation). Select exclusion criteria: intensive care unit admission, Coombs positivity, phototherapy before 60 hours of life, or no post-discharge TSB.
