First day bilirubin as a predictor of development of significant jaundice in term healthy neonates: a tertiary care hospital based study

Malik Shakir Hussain, Imran Ahmad Gattoo, Bilal Ahmad Najar, Muddasir Maqbool


Background: Neonatal jaundice is common and usually benign self-limited condition, but if severe can cause severe neurological damage.1 This prospective study was undertaken to determine the critical serum bilirubin level to predict the significant hyperbilirubinemia in healthy term new-borns based on the serum bilirubin measurement made within 24 hours of postnatal life. Present study was done to study the first day bilirubin as a predictor of development of significant jaundice in healthy term neonates.

Methods: The present study was conducted in the post graduate department of paediatrics Government Medical College Srinagar, tertiary care referral hospital. Total of 152 healthy term new-borns were included in the study. Micro capillary sample was taken on heel prick and centrifuge. Bilirubin estimation was done spectophotometrically using twin beam method (575-455) wave length bilinmicrometer. The infants were followed up clinically every 12 hours after initial bilirubin estimation till discharge the babies were recalled after discharge at 5 days of age. This study is a Prospective observational study.

Results: Initial bilirubin estimation was done on first postnatal day, and the range of initial bilirubin estimation was between 2.9-8 mg/dl. Clinically detectable jaundice was present in 110 (72.36%) patients. Out of 152 new-borns, 101 (66.44%) with serum bilirubin <6 mg/dl only 1 developed significant hyperbilirubinemia, were as 51 (33.52%) new-borns who had serum bilirubin >6 mg/dl 13 (25.46%) developed significant hyperbilirubinemia.

Conclusions: The present study found that a total serum bilirubin level of ≤6 mg/dl can be used to predict decreased risk for subsequent hyperbilirubinemia (TSB >17 mg/dl) with a sensitivity of 92.8% and negative predictive value of 99%. Such infants could thus be discharged early without need to follow up for hyperbilirubinemia later.


Hyperbilirubinemia, Incompatibility, Kernicterus, Sepsis, Oxytocin

Full Text:



American Academy of Paediatrics. Practice parameter management of hyperbilirubinemia in the healthy term new-born. Provisional Committee for Quality improvement and subcommittee on hyperbilirubinemia. Paediatrics. 1994;(1):558-65.

Mead Johnson, Johnson J. Glenview. Jaundice and your baby, 1993. Available at:

Richard E, Behrman, Robery M. Jaundice and hyperbilirubinemia in the new-born. In: Richard E, Behrman, Robery M, eds. Nelson Text Book of Paediatrics. 17th ed. Philadelphia: Saunders; 2003: 592-593.

Micheal T. Hinkes, John P. Cloherty. Bilirubin. In: Micheal T. Hinkes, John P. Cloherty, eds. Manual of Neonatal Care. 4th ed. New York: Little Brown & Co; 1998: 175-178.

Agarwal R, Monica Kaushal. Early neonatal hyperbilirubinemia using 1st day serum bilirubin level. Indian Paediatr. 2002;39:724-30.

Brown AK, Johnson L. Loss of concern about jaundice and the re-emergence of kernicterus in the era of managed care. In: Far-off AA, Klaus MH, eds. The Year Book of Neonatal and Perinatal Medicine. Philadelphia: Mosby Yearbook; 1996: 17-28.

Maize’s MJ, Newman TB. Kernicterus in otherwise healthy breast-fed term neonates. Paediatrics. 1995;96:730-3.

Alpay F, Sarici SU, Tosuncuk HD, Serdar MA, Inac N, Gokcay E. The value of the first day bilirubin measurement in predicting the development of significant hyperbilirubinemia in healthy term new-borns. Paediatrics. 2000;106:E16.

Ashok K. Deorari. Comparison of 1994 AAP guidelines with 2004 guidelines in Indian prospective. Paper Presentation. New Delhi: CME on Neonatal Care (AIIMS); Feb, 2005.

Britton HL, Britton JR. Efficacy of early new-born discharge in a middle class population. Am J Dis Child. 1984;138:1041-6.

Waldenstrom U. Early and late discharge after hospital birth: father’s involvement in infant care. Early Hum Dev. 1988;17:19-28.

V. I. V. Bewick, Jonathan Ball. Statistics review 13: receiver operator characteristics curves. Mathematical and Information Sciences University of Brington, Brington UK. Crit Care. 2004;8:508-12.

Buchan P. Pathogenesis of neonatal hyperbilirubinemia after inducting of labour with oxytocin. Br Med J. 1979;2:1255-7.

Maisels MJ, Kring E. Length of stay, jaundice and hospital readmission. Pediatrics.1988;10:995-8.