Prediction of significant hyperbilirubinemia using 24 hour serum bilirubin

Sai Sunil Kishore M., P. Tarakeswara Rao, K. Dinendraram


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.


24 hour bilirubin, Neonatal hyperbilirubinemia, Risk factors

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