Prediction Of Hyperbilirubinemia Research Articles

Role of Cord Blood Alkaline Phosphatase as a Predictor for Hyperbilirubinemia in Full-term Neonates

Role of Cord Blood Alkaline Phosphatase as a Predictor for Hyperbilirubinemia in Full-term Neonates

Deep-Learning-Based Smartphone Application for Self-Diagnosis of Scleral Jaundice in Patients with Hepatobiliary and Pancreatic Diseases.

Outpatient detection of total bilirubin levels should be performed regularly to monitor the recurrence of jaundice in hepatobiliary and pancreatic disease patients. However, frequent hospital visits for blood testing are burdensome for patients with poor medical conditions. This study validates a novel deep-learning-based smartphone application for the self-diagnosis of scleral jaundice in such patients. The system predicts total serum bilirubin levels using the deep-learning-based regression analysis of scleral photos taken by the smartphone’s built-in camera. Enrolled patients were randomly assigned to either the training cohort (n = 90, 1034 photos) or the validation cohort (n = 40, 426 photos). The intraclass correlation coefficient value for predicted serum total bilirubin (PSB) derived from the images repeatedly taken at the same time for the same patient showed good reliability (0.86). A strong correlation between measured serum total bilirubin (MSB) and PSB was observed in the subgroup with MSB levels ≥1.5 mg/dL (Spearman rho = 0.70, p < 0.001). The receiver operating characteristic curve for PSB showed that the area under the curve was 0.93, demonstrating good test performance as a predictor of hyperbilirubinemia (p < 0.001). Using a cut-off PSB ≥1.5, the prediction sensitivity of hyperbilirubinemia was 80.0%, with a specificity of 92.6%. Hence, the tool is effective for patient monitoring.

The early indicator of significant hyperbilirubinemia in healthy full-term infants at 72 hrs of age: A prospective cohort study

Introduction Hyperbilirubinaemia is a very common and frequently benign condition in newborns,but is a leading cause of hospitalisation in the first week of life. Many healthy full-term newbornsdevelop significant hyperbilirubinemia, often leading to serious complications as bilirubinencephalopathy and death. The present study was aimed to determine early predators and riskfactors in full-term healthy newborns developing significant hyperbilirubinemia. Methods - This wasa prospective observational cohort study conducted at the department of pediatrics at a tertiary careteaching hospital over 1 year enrolling 200 full-term healthy newborns and following them from birthto 72 hrs of life to determine early predictors of hyperbilirubinemia. The data were analysed usingthe Statistical Package of Social Science Software (SPSS) program. Bilirubin levels measured at 72hrs were compared to identify significant hyperbilirubinemia using cut off at or above highintermediate risk zone in Bhutani nomogram. Results- Neonates with birth weight &lt;2.5 kg, bornthrough instrumental delivery, delayed feeding, dehydration, 24 Hr serum bilirubin &gt;6mg/dl and 48Hr serum bilirubin &gt;11 mg/dl were significantly associated with significant hyperbilirubinemia(p&lt;0.05) Conclusion- These risk factors can be used as risk indicator to predict the development ofsignificant hyperbilirubinemia in such newborns and better pre-discharge counselling and followupcan be ensured in such newborns especially in resource-limited settings.

Direct antiglobulin test in the prediction of hyperbilirubinemia and predischarge bilirubin levels in infants with mother-infant blood type incompatibility

This research evaluated the association between the mother-infant blood type or rhesus (ABO or Rh) incompatibility, the pattern of neonatal jaundice, and serum bilirubin (TSB) values obtained prior to discharge from hospital of healthy born neonates with gestational age >34 weeks and birth weight >2000 g. We utilized a laboratory and neonatal database to identify the cord blood ABO/Rh and direct antiglobulin test (DAT) and TSB measured during hospitalization and re-admission with hyperbilirubinemia for phototherapy treatment. We used hour-specific TSB to analyze the TSB levels for ABO/Rh compatibility and isoimmunization using chi-square, analysis of variance, and regression models. Of the 901 infants studied, 158 (17.5%) had ABO/Rh incompatibility, including 27 with positive DAT. Hyperbilirubinemia was diagnosed in 33.3% DAT positive, 6.9% DAT negative, and 4.6% of infants with compatible blood types. Increased predischarge TSB was observed in DAT positive infants at 48-72 h of postnatal age (P < 0.001). After controlling for age at TSB testing and weight loss percentage, multiple regression analysis did not show any impact of ABO/Rh incompatibility and DAT results on the predischarge TSB levels. Blood type incompatibility increases the frequency of hyperbilirubinemia only in the DAT-positive infants. Irrespective of the isoimmunization status, it does not significantly affect the level of predischarge TSB.

Predictive value of cord blood bilirubin in neonatal hyperbilirubinemia: A prospective study

Background: As there is a tendency for early discharge from a hospital, some babies may develop significant neonatal jaundice at home, which may go unrecognized and cause subclinical damage to the growing brain. If such babies could be identified early, their discharge can be postponed for timely and better management. Objectives: The objectives of the study were to evaluate the umbilical cord bilirubin (UCB) levels as a predictor for hyperbilirubinemia in full-term and near-term newborns up to the 3rd day of life. Materials and Methods: A prospective cohort study was carried out in a tertiary care hospital in South India. Data were collected from the enrolled cases by a pre-designed proforma. Statistical analysis was carried out with the help of statistical measures, such as percentages and proportions and the sensitivity, specificity, and negative and positive predictive values (NPV and PPV). Results: A total of 301 newborns were enrolled. A cutoff UCB 2 mg/dl had 94% sensitivity, 93% specificity, 61% PPV, and 99% NPV. A total of 61% of neonates who had UCB levels ?2 mg/dL required phototherapy by the 3rd day of life. However, 99% of neonates who had UCB &lt;2 mg/dL did not require phototherapy, and these infants with low risk of hyperbilirubinemia could be discharged early from the hospital. Conclusion: The cutoff value of 2 mg/dL of UCB with 94% sensitivity and 93% specificity canbe used as a predictor for developing subsequent hyperbilirubinemia.

Evaluation of cord blood alkaline phosphatase levels as an indicator of neonatal jaundice

Introduction Neonatal jaundice remains an important neonatal issue, and the condition is mostly benign. Jaundice is a complex disease of high bilirubin levels in the body and yellowing of the skin and mucous membranes. Hyperbilirubinemia is associated with encephalopathy and kernicterus, resulting in permanent disability. Because babies are discharged early, detection and diagnosis of hyperbilirubinemia are delayed in some cases. Therefore, early diagnosis of jaundice and timely actions are necessary. Several methods have been used to determine the risk of neonatal hyperbilirubinemia. Alkaline phosphatase (ALP) is an intracellular enzyme found abundantly in red blood cells. It is a hydrolase enzyme and responsible for removing phosphate from many types of molecules. Our aim in this study was to investigate whether cord blood ALP level during the first 6 h of live of newborn could be used for the early diagnosis and prediction of hyperbilirubinemia in newborns. Patients and methods This was a prospective study carried out during the period from June 2018 to December 2018 at El-Mania General Hospital. This study included a total of 60 neonates: 30 full-term infants and 30 preterm infants. A total of 60 babies were evaluated, starting from the sixth hour after birth, and cord blood ALP levels were analyzed. We performed an assessment of the complete medical history (maternal history and neonatal history). Third day of live measured transcutaneous bilirubin of neonate, and seventh day we measured serum bilirubin (total and direct). Results The present study showed that infants with high cord blood ALP levels are at risk of developing significant indirect neonatal hyperbilirubinemia that requires interventions with an accuracy of 82.2%, a sensitivity of 72%, a specificity of 85.71%, a positive predictive value of 83.43%, and a negative predictive value of 75.37%. Conclusion The cord blood ALP level can be used as a predictor of severe neonatal jaundice.

Evaluation of cord blood alkaline phosphatase as a predictor of hyperbilirubinemia in Egyptian neonates

Background/aim Hyperbilirubinemia is a major cause of neonatal morbidity. It affects nearly 60% of term and 80% of preterm neonates during the first week of life. Early prediction of hyperbilirubinemia will help in early discharge and prevent hospitalization of babies and mothers for longer periods. The aim of this study was to verify whether the cord alkaline phosphatase (ALP) levels can predict the development of neonatal hyperbilirubinemia. Participants and methods This prospective study was conducted at Alglaa Teaching Hospital from June 2016 to May 2018. A total of 200 healthy term and late preterm neonates meeting the inclusion criteria were enrolled in this study (gestational age >35 weeks of either sex, from any mode of delivery, and Apgar score ≥7 at first and fifth minutes of life). After birth, cord blood was collected for the estimation of cord blood ALP and serum total bilirubin. Results The incidence of clinical jaundice in our study was 50.54% (94 cases). Only 28.72% (27 cases) of them required treatment. There is a significant association between cord blood ALP levels and the development of hyperbilirubinemia requiring treatment. Receiver operating characteristic curve analysis demonstrates that ALP level of the cord blood greater than 342 IU/l was the most appropriate cutoff value for predicting significant jaundice (that needs treatment). It was associated with 91.07% sensitivity and specificity 61.54%. The area under the curve was 0.791, indicating the high significance and the usefulness of this assay in predicting significant jaundice requiring medication. Conclusion This study concludes that cord blood ALP levels reliably predict the occurrence of pathological hyperbilirubinemia requiring therapy as defined by the current operational guidelines.

Prevalence of neonatal jaundice at a tertiary health institution in Ondo state, Nigeria

1. Sarici SU, Serdar MA, Korkmz A. Incidence, course and prediction of hyperbilirubinaemia in near term and term newborns. Paediatrics. 2004; 113: 775–780. CrossRef Google Scholar

Are Cord Blood Bilirubin Values Trustable to Predict the Forthcoming Significant Hyperbilirubinemia Requiring Treatment in Healthy Term Newborns?

Background: Jaundice is a clinical condition that is often observed in pediatric practice and constitutes one of the major issues within the neonatal period. As severe jaundice causes neurotoxicity(kernicterus), the diagnosis and treatment of severe hyperbilirubinemia is very important. Early prediction will help in early discharge and will prevent hospitalization of babies and mothers. On the other hand, predicting outcome in high risk neonates for subsequent hyperbilirubinemia is required.Objectives: This study investigates the predictive value of umbilical cord serum bilirubin (UCSB) for subsequent hyperbilirubinemia which is a required treatment in healthy term newborns.Methods: In this prospective study, 238 healthy term newborns were inducted into the study. Soon after delivery, the cord blood was sent for serum bilirubin analysis. Newborns were followed up by TCB (transcutaneous bilirubinometry) until the third day post birth and those who showed significantly high TCB values, according to the hour-specific normogram, received the appropriate intervention and treatment. The data were analyzed using t-Test, ROC (receiver operating characteristic) curve, and chi-square tests.Results: Of 238 newborns, 27 (11.4%) cases developed hyperbilirubinemia (bilirubin >= 15 mg/dL), which required phototherapy. There were no significant differences between the cases who did and who did not develop hyperbilirubinemia (bilirubin = 2.25 mg/dl had high sensitivity (92.6%), good positive and negative predictive value (66% and 69% respectively).Conclusions: UCSB level >= 2.25 mg/dL can be a useful predictor of hyperbilirubinemia in healthy term newborns on the third day. Therefore, infants with UCSB level >= 2.25 mg/dL should be followed up strictly either in a hospital or in an outpatient department on the third day, whereas neonates with cord bilirubin level < 2.25 mg/dL are probably safe for early discharge.

Alkaline phosphatase and haptoglobin as predictor of neonatal jaundice

Background: The term kernicterus refers to the clinical features of bilirubin encephalopathy. Its risk is increased in term babies with very high bilirubin levels. Kernicterus is also known to occur at lower levels of bilirubin in term babies who have risk factors and in preterm babies. Objective: The aim of the present study was to investigate whether serum alkaline phosphatse & haptoglobin (Hp) level could be used for the early diagnosis and prediction of hyperbilirubinemia in newborns. Methodology: The study is a prospective clinical study design, which was carried out in Pediatric Department, Faculty of Medicine, Aswan University Hospital. The study included 100 newborns with gestational age more than 35wk delivered in obstetric department. Results: Our study showed no statistically significant difference between jaundiced and non- jaundiced cases regarding the mode of delivery, maternal gravidity and parity. As regards previous sibiling affected, we found a significant relation between clinically appearing jaundice and previous sibling affected with neonatal hyperbillirubinemia, which may reflect genetic susceptibility for hyperbillirubinemia. No significant relationship between gestational age and clinically appearing jaundice. When assessing the relationship between clinically appearing jaundice and birth weight, our results revealed no significant relationship. Conclusion: The cord blood alkaline phosphatase level is not only a useful predictor for severe neonatal jaundice but also can predict the early onset of neonatal hyperbilirubinemia and expected methods of treatment in healthy newborns more than 35 weeks gestational age.

Alkaline phosphatase and haptoglobin as predictor of neonatal jaundice

Background: The term kernicterus refers to the clinical features of bilirubin encephalopathy. Its risk is increased in term babies with very high bilirubin levels. Kernicterus is also known to occur at lower levels of bilirubin in term babies who have risk factors and in preterm babies. Objective: The aim of the present study was to investigate whether serum alkaline phosphatse & haptoglobin (Hp) level could be used for the early diagnosis and prediction of hyperbilirubinemia in newborns. Methodology: The study is a prospective clinical study design, which was carried out in Pediatric Department, Faculty of Medicine, Aswan University Hospital. The study included 100 newborns with gestational age more than 35wk delivered in obstetric department. Results: Our study showed no statistically significant difference between jaundiced and non- jaundiced cases regarding the mode of delivery, maternal gravidity and parity. As regards previous sibiling affected, we found a significant relation between clinically appearing jaundice and previous sibling affected with neonatal hyperbillirubinemia, which may reflect genetic susceptibility for hyperbillirubinemia. No significant relationship between gestational age and clinically appearing jaundice. When assessing the relationship between clinically appearing jaundice and birth weight, our results revealed no significant relationship. Conclusion: The cord blood alkaline phosphatase level is not only a useful predictor for severe neonatal jaundice but also can predict the early onset of neonatal hyperbilirubinemia and expected methods of treatment in healthy newborns more than 35 weeks gestational age.

Prospective study on cord bilirubin level as a predictor of Hyperbilirubinemia in term healthy neonates

Prospective study on cord bilirubin level as a predictor of Hyperbilirubinemia in term healthy neonates

ASSESMENT OF CORD BLOOD ALBUMIN AS A PREDICTOR OF HYPERBILIRUBINEMIA

ASSESMENT OF CORD BLOOD ALBUMIN AS A PREDICTOR OF HYPERBILIRUBINEMIA

The first 24-hour bilirubin level as a predictor of hyperbilirubinemia in healthy term newborns

Background Early discharging healthy term newborns results ina difficulty to recognize hyperbilirubinemia.Objective The aim of this study was to determine the value of thefirst 24-hour total and unbound bilirubin levels in predicting hyper-bilirubinemia in healthy term newborns.Methods The first 24-hour and the 5 th day total and unboundbilirubin levels were measured in 84 healthy term newborns. Thetotal bilirubin level was measured spectrophotometrically, whereasunbound bilirubin level was determined by peroxidase-oxidationmethod. Hyperbilirubinemia was defined as serum total bilirubin of&gt;12.9 mg/dL or serum unbound bilirubin of &gt;0.5 mg/dL after 24hours of life.Results A correlation between the first 24-hour and the 5 th daytotal bilirubin levels was found (r= 0.53) with a regression equa-tion: Y (total bilirubin on day 5) = 4.69 + 1.15X (total bilirubin in thefirst 24 hours). In unbound bilirubin (r=0.31), the regression equa-tion was Y (unbound bilirubin on day 5) = 0.13 + 0.95X (unboundbilirubin in the first 24-hours). The relative risk for developing hy-perbilirubinemia in newborns whose TB 1 was &gt;4.5 mg/dL was 12(95% CI 2.9;48.4), whereas newborns whose UB 1 was &gt;0.09 mg/dL was 9.5 (95% CI 1.2;77.4).Conclusion Total bilirubin level of &gt;4.5 mg/dL in the first 24 hourscan predict the development of hyperbilirubinemia in term new-borns in the first week of life. Newborns with such level of totalbilirubin need a longer stay or should visit the hospital on day 5-7

To Assess Predictive Value of Cord Blood Bilirubin and Albumin for Significant Neonatal Hyperbilirubinemia: A Prospective Study from India

Aim: To assess the usefulness of the cord blood bilirubin and cord albumin estimation as a predictor of subsequent neonatal hyperbilirubinemia in a healthy term infants and to compare their predictive abilities: a prospective study. Material and Method: This study enrolled 200 full term neonates during the study period. Bilirubin and albumin estimation was done from cord blood, 1st day, 3rd day and 5th day bilirubin estimation was done from peripheral venous blood. Relationship was seen between level of albumin and bilirubin. Result: Cord blood bilirubin level of >2 mg/dl had a sensitivity of 90% and specificity of 53.89%, positive predictive value 17.8% and negative predictive value of 98% in predicting the risk of neonatal hyperbilirubinemia. (p<.001). Cord blood albumin level of ≤2.6 gm/dl had a sensitivity of 80% and specificity of 86.67%, positive predictive value 40% and negative predictive value of 97.5% in predicting the risk of neonatal hyperbilirubinemia (p<.0001) 1st day bilirubin level of ≥5.7 mg/dl had a sensitivity of 90% and specificity of 82.22%, positive predictive value of 36% and negative predictive value of 98.7% in predicting the risk of neonatal hyperbilirubinemia(p<.0001). Conclusion: Cord bilirubin and albumin can be used as predictor for hyperbilirubinemia and for early review for jaundice especially in developing countries where regular follow up is difficult.

Prediction of Hyperbilirubinemia in Preterm Newborns Admitted in a Tertiary Care Teaching Hospital

Introduction: Neonatal hyperbilirubinemia is a cause of major concern for the parents as well as the pediatricians due to chance of neurotoxicity. Early prediction of development of significant hyperbilirubinemia can reduce anxiety and duration of hospital stay. Objective: To find out the risk of development of significant hyperbilirubinemia among preterm newborn within first seven days of life. Methodology: This prospective study was carried out in Dhaka Shishu Hospital during the period of January to June, 2007. One hundred &amp; eleven preterm newborns of 30-37 weeks gestational age were enrolled in first day of their life and their serum total and indirect bilirubin were estimated on the 1st, 2nd, 5th &amp; 7th day. Neonates with evidence of hemolysis, direct hyperbilirubinemia, sepsis &amp; major congenital malformation were excluded. Their 1st and 2nd day serum total bilirubin values were analyzed statistically at different cut off points from which significant hyperbilirubinemia can develop on 5th &amp; 7th day of life. Results: The study included 111 premature neonates of 30-37 weeks gestation who were enrolled on first day of their life. Their mean gestational age was 33.7(±2) weeks and mean birth weight was 1754(±341) gm. Of them, 38 (34%) neonates developed significant hyperbilirubinemia within first seven days of life. Among the study population, 40 (36%) neonates had serum total bilirubin value of &lt;2 mg/dL on first day of life. None of them developed significant hyperbilirubinemia (100% negative predictive value). Again 65 (58.5%) neonates had serum total bilirubin value of &lt;5 mg/dL on second day of life. Among them only 7.6% developed significant hyperbilirubinemia (92.3% negative predictive value). Conclusion: The first and second day serum total bilirubin values can predict subsequent hyperbilirubinemia within seven days of life. First day serum total bilirubin value of 2 mg/dL can be taken as a safe limit from which chance of significant hyperbilirubinemia is less. DOI: http://dx.doi.org/10.3329/bjch.v37i2.17265 BANGLADESH J CHILD HEALTH 2013; VOL 37 (2) : 85-89

Alkaline phosphatase as an early marker of hemolysis in newborns

Early diagnosis and appropriate management of neonatal hyperbilirubinemia are very important in order to prevent bilirubin encephalopathy and kernicterus. Several diagnostic tests may be used for this purpose, including bilirubin level itself. The aim of the present study was to investigate whether serum alkaline phosphatase (ALP), which is an intracellular enzyme found abundantly in red blood cells, could be used for the early diagnosis and prediction of hyperbilirubinemia in newborns. A total of 100 babies were evaluated, starting from the sixth hour after birth, and serum ALP and bilirubin levels were analyzed. ALP levels were significantly higher in babies requiring therapy such as phototherapy or exchange transfusion (247.01 ± 67.44 IU/L vs 154.25 ± 56.07 IU/L). ALP levels rose significantly with rising total bilirubin level. ALP levels at the sixth hour of life may be a significant predictor of developing hemolysis and hyperbilirubinemia requiring treatment.

Does Measuring the Changes in TcB Value Offer Better Prediction of Hyperbilirubinemia in Healthy Neonates?

We evaluated the diagnostic value of changes in transcutaneous bilirubin (TcB) levels for prediction of subsequent hyperbilirubinemia in healthy term and late-preterm neonates. Neonates at 35 weeks of gestation were enrolled in a prospective study. Two TcB determinations were performed for all enrolled neonates (N = 358). The first assessment (TcB(1)) was performed at 24 +/- 6 hours of age, followed by a second (TcB(2)) >or=12 hours later. Changes in TcB levels were calculated. TcB values were plotted on an hour-specific serum bilirubin nomogram, and risk zones were recorded. Of the 358 neonates enrolled, 325 neonates (91%) were monitored for hyperbilirubinemia until 5 days of age. The mean ages of TcB(1) and TcB(2) estimations were 23 +/- 4 hours and 42 +/- 4 hours, respectively. A total of 14.9% of neonates (48 of 325 neonates) developed hyperbilirubinemia by 5 days of age. The sensitivity, specificity, and positive and negative likelihood ratios for prediction of subsequent hyperbilirubinemia for TcB(1) (zone >2, >75th percentile) were 80.4%, 58.0%, 1.9, and 0.34; those for TcB(2) (zone >2, >75th percentile) were 82.6%, 79.0%, 4.0, and 0.22; and those for the change in TcB levels (>0.18 mg/dL per hour, >75th percentile) were 82.5%, 82.9%, 4.8, and 0.21, respectively. Gestational age, TcB risk zone, and change in TcB levels were found to be independent predictors of subsequent hyperbilirubinemia. Single TcB measurements at 30 to 48 hours predict hyperbilirubinemia with a reasonably high degree of accuracy. Changes in TcB levels do not offer any added clinical benefit.

Studies in hemolysis in glucose-6-phosphate dehydrogenase-deficient African American neonates

Background The role of hemolysis in the mechanism and prediction of hyperbilirubinemia was contrasted between glucose-6-phosphate dehydrogenase (G-6-PD)-deficient and -normal African American neonates. Methods Corrected end tidal carbon monoxide (ETCOc) values from the subset of male neonates born to non-smoking African American mothers, drawn from a previously published study, were analyzed. The relationship between ETCOc and bilirubin values, the latter represented as percentiles on the hour of life specific bilirubin nomogram, was determined. Hyperbilirubinemia was defined as any bilirubin value ≥ 95th percentile for hour of life. Results 18.6% of 59 G-6-PD-deficient neonates developed hyperbilirubinemia, compared with 7.5% of 362 controls (relative risk 2.50, 95% confidence interval 1.31 to 4.76). As reported, ETCOc values (median, interquartile range) were significantly higher among G-6-PD-deficient neonates than controls (2.4 [2.0–2.9] vs. 2.1 [1.7–2.5] ppm, p < 0.001. However, higher ETCOc values were limited to those G-6-PD-deficient neonates with lower bilirubin percentiles: among those whose bilirubin value did not exceed the 95th percentile ETCOc was 2.30 [2.00–2.85] vs. 2.00 [1.70–2.40] ppm in controls, p = 0.001. In contrast, among the hyperbilirubinemic neonates ETCOc values were similar between G-6-PD-deficient neonates and controls: 2.7 [2.03–3.33] vs. 2.6 [2.33–3.45] ppm, p = 0.9. In the G-6-PD-deficient neonates ETCOc ≥ 75th percentile contributed no additional predictive value for hyperbilirubinemia (likelihood ratio 1.8). Conclusions G-6-PD-deficient African American neonates have increased hemolysis and increased rate of hyperbilirubinemia, but the hemolysis is neither a predominant factor in the pathogenesis of hyperbilirubinemia nor is it predictive of hyperbilirubinemia, over and above the already increased risk conferred by G-6-PD deficiency.

Prediction of Hyperbilirubinemia in Near-Term and Term Infants

The purpose of this study was to determine whether end-tidal carbon monoxide (CO) corrected for ambient CO (ETCOc), as a single measurement or in combination with serum total bilirubin (STB) measurements, can predict the development of hyperbilirubinemia during the first 7 days of life. From nine multinational clinical sites, 1370 neonates completed this cohort study from February 20, 1998 through February 22, 1999. Measurements of both ETCOc and STB were performed at 30+/-6 hours of life; STB also was measured at 96+/-12 hours and subsequently following a flow diagram based on a table of hours of age-specific STB. An infant was defined as hyperbilirubinemic if the hours of age-specific STB was greater than or equal to the 95th percentile as defined by the table at any time during the study. A total of 120 (8.8%) of the enrolled infants became hyperbilirubinemic. Mean STB in breast-fed infants was 8.92+/-4.37 mg/dl at 96 hours versus 7.63+/-3.58 mg/dl in those fed formula only. The mean ETCOc at 30+/-6 hours for the total population was 1.48+/-0.49 ppm, whereas those of nonhyperbilirubinemic and hyperbilirubinemic infants were 1.45+/-0.47 and 1.81+/-0.59 ppm, respectively. Seventy-six percent (92 of 120) of hyperbilirubinemic infants had ETCOc greater than the population mean. An ETCOc greater than the population mean at 30+/-6 hours yielded a 13.0% positive predictive value (PPV) and a 95.8% negative predictive value (NPV) for STB > or =95th percentile. When infants with STB > or =95th percentile at <36 hours of age were excluded, the STB at 30+/-6 hours yielded a 16.7% PPV and a 98.1% NPV for STB >75th percentile. The combination of these two measurements at 30+/-6 hours (either ETCOc more than the population mean or STB >75th percentile) had a 6.4% PPV with a 99.0% NPV. This prospective cohort study supports previous observations that measuring STB before discharge may provide some assistance in predicting an infant's risk for developing hyperbilirubinemia. The addition of an ETCOc measurement provides insight into the processes that contribute to the condition but does not materially improve the predictive ability of an hours of age-specific STB in this study population. The combination of STB and ETCOc as early as 30+/-6 hours may identify infants with increased bilirubin production (eg, hemolysis) or decreased elimination (conjugation defects) as well as infants who require early follow-up after discharge for jaundice or other clinical problems such as late anemia. Depending on the incidence of hyperbilirubinemia within an institution, the criteria for decision making should vary according to its unique population.