Prediction of significant hyperbilirubinemia using 24 hour serum bilirubin


  • Sai Sunil Kishore M. Department of Pediatrics, Maharajahs Institute of Medical Sciences, Vizianagaram, Andhrapradesh, India
  • P. Tarakeswara Rao Department of Pediatrics, Maharajahs Institute of Medical Sciences, Vizianagaram, Andhrapradesh, India
  • K. Dinendraram Department of Pediatrics, Maharajahs Institute of Medical Sciences, Vizianagaram, Andhrapradesh, India



24 hour bilirubin, Neonatal hyperbilirubinemia, Risk factors


Background: Neonatal hyperbilirubinemia (NH) is a common problem affecting nearly 60% of term and 80% of preterm neonates during first week of life. Early discharge of healthy term newborns is a common practice because of various constraints in resource poor settings. The present study was conducted to determine predictive ability of 24 hour serum bilirubin for subsequent significant hyperbilirubinemia and to identify risk factors in healthy term newborns.

Methods: The present study was conducted on 250 term healthy neonates delivered at tertiary care hospital. Serum bilirubin level was estimated at 24±2 hours of age.  The main outcome measured was ‘significant’ hyperbilirubinemia requiring treatment (phototherapy/exchange transfusion).The newborns were followed up clinically till 5th day of life. Serum bilirubin was estimated clinically as indicated and on day 5 of life.

Results: By ROC analysis 24 hour serum bilirubin level of >4.75 mg/dl was found to have highest sensitivity of 82.5%, specificity of 81.9%, positive predict value of 46.5% and negative predict value of 96.1%. Newborn babies with 24 hours serum bilirubin level of >4.75 mg/dl had a significant risk of developing neonatal hyperbilirubinemia, as observed by the serum bilirubin levels on day five. Mode of delivery, order of birth and oxytocin induction during labour associated with significant risk of hyperbilirubinemia.

Conclusions: 24 hour bilirubin level of more >4.75mg/dl can reliably predict neonatal hyperbilirubinemia in healthy term neonates.


Anthony JP, Barbara JS. The new born infant, Digestive system disorders: Jaundice and hyperbilirubinemia in the newborn. In: Richard E. Behrman, Robert M. Kliegman, Hal B., Bonita F. Stanton, Editors, Nelson Textbook of Pediatrics: 18th ed. Philadelphia: Saunders Elsevier; 2008:756-66.

Mary LP, Gregory, Martin CR, Cloherty JP. Neonatal Hyperbilirubinemia. In Cloherty JP, Eichenwald EC, Hansen AR, Stark AR eds. Manual of neonatal care: 7th Ed. New Delhi: Wolters Kluwer.2012:304-39.

Maisles MJ, Newman TB. Kernicterus in otherwise healthy breast-fed Term Newborns. Pediatrics. 1995;96:730-3.

Catz C, Hanson JW, Simpson L, Yaffe SJ. Summary of workshop: Early Discharge and Neonatal Hyperbilirubinemia. Pediatrics. 1995;96:743

American Academy of Pediatrics clinical practice guideline and subcommittee on hyperbilirubinemia. Management of hyperbilirubinemia in the newborn Infant 35 or more weeks of Gestation. Pediatrics.2004;114:297-316.

Bhutani VK, Jhonson L, Sivieri EM. Predictive ability of a predischarge Hour- specific serum bilirubin for subsequent significant Hyperbilirubinemia in healthy term and near Newborns. Pediatrics. 1999;103:6-14.

Gupta PC, Kumari S, Mullick DN. Icterometer; useful screening tool for neonatal Jaundice. Indian Pediatr. 1991;28:473-6.

Kumar A, Faridi MM, Singh N, Ahmad SH. Transcutaneous bilirubinometry in the management of bilirubinemia in term neonates. Indian J Med Res. 1994;99:227-30.

Rosenfeld J. Umbilical cord bilirubin levels as a predictor of subsequent hyperbilirubinaemia. J FAM Pract. 1986;23(6):555-8.

Risemberg HM, Mazzi E, MacDonald MG, Peralta M, Heldrich F. Correlation of cord bilirubin levels with hyperbilirubinaemia in ABO incompatibility. Arch Dis Child. 1977;52:219-22.

Randev S, Grower N. Predicting neonatal hyperbilirubinemia using first day serum bilirubin levels. Indian J Pediatr. 2010;77:147-50.

Penn AA, Enzmann DR, Hahn JS, Stevenson DK. Kernicterus in a full term infant. Pediatrics. 1994;93:1003-6.

Newman TB, Maisles MJ. Does hyperbilirubinemia damage the brain of healthy full-term infants? Clin Perinatol. 1990;17:331-58.

Seidman DS, Ergaz Z, Paz I, Laor A, Revel-Vilk S, Stevenson DK, et al. Predicting the risk of jaundice in full-term healthy newborns: a prospective population based study. J Perinatol. 1999;19:564-7.

Amar T, Krishna V, Manish J, Preeti Z, Suchita A, Sherin V. Prediction of the development of neonatal hyperbilirubinemia by increased umbilical cord blood bilirubin. Ind Medica. 2005;9(1):5-9.

Rudy S, Sjarif HE, Dida AG. Correlation between cord blood bilirubin level and incidence of hyperbilirubinemia in term newborns. Paediatrica Indonesiana. 2009;49(6):349-54.

Phelan JG, Taylor JA, Liu LL, Davis RL. Early newborn hospital discharge and readmission for mild and severe jaundice. Arch Pediatr Adolesc Med. 1999;153:1283-8.

Singhal V, Kamath N, Baliga BS, Unnikrishnan B. Cord blood bilirubin level, an early predictor of neonatal hyperbilirubinemia. Perinatology. 2012;13(1):1-8.

Rostami N, Mehrabi Y. Identifying the newborns at risk for developing significant hyperbilirubinemia by measuring cord bilirubin levels. J Arab Neonatal Forum. 2005;2:81-5.

Knudsen A. Prediction of the development of neonatal jaundice by increased umbilical cord blood bilirubin. Acta pediatr Scand. 1989;78(2):217-21.

Srivastava N, Pande US, Malik GK, Singh SS, Singh SK. A study of serum bilirubin in neonates in relation to the maternal age. Indian J Med Sci. 1999;53:158‑61.

Oral E, Gezer A, Cagdas A, Pakkal N. Oxytocin infusion in labor: the effect different indications and the use of different diluents on neonatal bilirubin levels. Archgynecol Obstet. 2003;267(3):117-20.

Awasthi S, Rehman H. Early prediction of neonatal hyperbilirubinemia. Indian J Pediatr. 1998;65:131-9.

Rina T, Ekawaty LH, Achmad S. The first 24-hour bilirubin level as a predictor of hyperbilirubinemia in healthy term newborns. Pediatrica Indonesaina. 2003;43:5-6.

Alpay F, Sarici SU, Tosuncuk HD, Serdar MA, Inanç N, Gokcay E. The Value of First Day Bilirubin Measurement in Predicting the Development of Significant Hyperbilirubinemia in Healthy Term Newborns. Pediatrics. 2000;106(2):1-5.






Original Research Articles