Comparison between 1st and 2nd day serum bilirubin levels in relation to the prediction of requirement of phototherapy in neonates of ≥35 weeks of gestation

Abstract

Background: Follow-up of neonates discharged early is essential to identify neonates at risk of hyperbilirubinemia. The present study was conducted to evaluate and compare 20 ± 4 and 44 ± 4 h serum bilirubin level for predicting significant hyperbilirubinemia and requirement of follow-up after discharge. Materials and Methods: This study was a hospital-based prospective study. A total of 300 healthy newborns were included with gestational age of ≥35 weeks. Serum bilirubin levels on the 1st day and 2nd day were measured by microbilirubinometer at 20 ± 4 h of life and 44 ± 4 h of life, respectively. Results: In our study, we found that, for bilirubin level of >6 mg/dl for neonates at 20 ± 4 h of age requiring phototherapy for hyperbilirubinemia, sensitivity was 79.3%, specificity was 60.9%, positive predictive value (PPV) was 17.8%, and negative predictive value (NPV) was 96.4%. At 44 ± 4 h of life, for bilirubin level of >9 mg/dl requiring phototherapy for hyperbilirubinemia, sensitivity was 89.7%, specificity was 64.2%, PPV was 21.1%, and NPV was 98.3%. Conclusion: Babies with total serum bilirubin values below 6 mg/dl at 20 ± 4 h and 9 mg/dl at 44 ± 4 h can well be discharged early with proper discharge advice. Babies with serum bilirubin levels above the cutoff value (6 mg/dl at 20 ± 4 h and 9 mg/dl at 44 ± 4 h) can be discharged after 24 h or 48 h, but requires frequent follow-ups in the 1st week of life.