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

Abstract

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 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.