PEDIATRICS Vol. 106 No. 2 August 2000, p. e16
ELECTRONIC ARTICLE:
The Value of First-Day Bilirubin Measurement in Predicting the
Development of Significant Hyperbilirubinemia in Healthy Term Newborns
Received Oct 27, 1999; accepted Feb 24, 2000.
,
From the Departments of * Pediatrics and Clinical
Biochemistry, Gülhane Military Medical Academy, Ankara, Turkey.
Objective. The recognition, follow-up, and early treatment of neonatal jaundice has become more difficult, since the earlier discharge of newborns from hospitals has become common practice. This prospective study was undertaken to identify the newborns at risk for developing significant hyperbilirubinemia later during the first days of life by measuring the serum bilirubin levels of the first 5 days of life to determine the critical predictive serum bilirubin value on the first day of life.
Methodology. A total of 498 healthy term newborns were
followed with daily serum total bilirubin measurements for the first 5 days of life, and cases with serum bilirubin levels of 
17 mg/dL after
24 hours of life were defined to have significant
hyperbilirubinemia.
Results. No newborns had a serum total bilirubin level of
17 mg/dL in the first 72 hours of life. Sixty of 498 cases (12.05%)
had significant hyperbilirubinemia after 72 hours of life, and these cases had significantly higher bilirubin levels than those who did not
develop significant hyperbilirubinemia on each of the first 5 days'
measurements. Of the 206 newborns who had a serum bilirubin level of
6 mg/dL in the first 24 hours, 54 (26.21%) developed significant
hyperbilirubinemia, whereas only 6 of the 292 newborns (2.05%) who had
a serum bilirubin level of <6 mg/dL on the first day developed
significant hyperbilirubinemia. A mean serum bilirubin level of 6
mg/dL on the first day had the highest sensitivity (90%). At this
critical serum bilirubin value, the negative predictive value was very
high (97.9%) and the positive predictive value was fairly low
(26.2%). Furthermore, because no cases with a serum bilirubin level of
<6 mg/dL in the first 24 hours of life required a subsequent
phototherapy treatment and because all of those infants requiring a
phototherapy treatment with serum bilirubin levels of 20 mg/dL were
just among the cases whose first-day bilirubin levels were 6 mg/dL,
the critical bilirubin level of 6 mg/dL on the first day made it
possible, with the highest (100%) sensitivity and negative predictive
value, to definitely predict all of the infants who would
have a bilirubin level of >20 mg/dL, requiring a phototherapy
treatment later during the first days of life.
Conclusions. A serum bilirubin measurement and the use of the critical bilirubin level of 6 mg/dL in the first 24 hours of life will predict nearly all of the term newborns who will have significant hyperbilirubinemia and will determine all those who will require a phototherapy treatment later during the first days of life. Key words: early discharge, jaundice, newborn, prediction, significant hyperbilirubinemia.
