Gastroenterology Book

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Neonatal Bilirubin

Aka: Neonatal Bilirubin, Bilirubin in Newborns
  1. See Also
    1. Bilirubin
    2. Neonatal Jaundice
    3. Neonatal Jaundice Causes
    4. Phototherapy
    5. Exchange Transfusion in Newborns
    6. Liver Function Test
    7. Liver Function Test Abnormality
  2. Resources
    1. Bilirubin Tool
      1. http://www.bilitool.com
  3. Interpretation: Risk of Hyperbilirubinemia in term infants (>36 weeks and >2 kg, or >35 weeks and >2.5 kg)
    1. See Severe Neonatal Hyperbilirubinemia Risk Factor
    2. See Exchange Transfusion in Newborns
    3. See Phototherapy
    4. Phototherapy is indicated when a threshold is crossed based on an infants Hyperbilirubinemia risk factors
      1. High Risk Infant
        1. Gestational age >35 weeks AND <38 weeks AND Severe Neonatal Hyperbilirubinemia Risk Factor
      2. Intermediate Risk Infant
        1. Gestational age >38 weeks AND Severe Neonatal Hyperbilirubinemia Risk Factor OR
        2. Gestational age >35 weeks AND <38 weeks AND No Risk Factors
      3. Low Risk Infant
        1. Gestational age >38 weeks AND No Risk Factors
    5. Age 12 hours of life
      1. High risk Infant: Serum Bilirubin >3.9 mg/dl
      2. Intermediate risk Infant: Serum Bilirubin >5 mg/dl
      3. Low risk Infant: Serum Bilirubin >7.1 mg/dl
      4. Minimal risk transcutaneous Bilirubin <4 mg/dl
    6. Age 24 hours of life
      1. High risk Infant: Serum Bilirubin >4.9 mg/dl
      2. Intermediate risk Infant: Serum Bilirubin >6 mg/dl
      3. Low risk Infant: Serum Bilirubin >7.7 mg/dl
      4. Minimal risk transcutaneous Bilirubin <5.5 mg/dl
    7. Age 36 hours of life
      1. High risk Infant: Serum Bilirubin >7 mg/dl
      2. Intermediate risk Infant: Serum Bilirubin >9 mg/dl
      3. Low risk Infant: Serum Bilirubin >11 mg/dl
      4. Minimal risk transcutaneous Bilirubin <8 mg/dl
    8. Age 48 hours of life
      1. High risk Infant: Serum Bilirubin >8.6 mg/dl
      2. Intermediate risk Infant: Serum Bilirubin >10.8 mg/dl
      3. Low risk Infant: Serum Bilirubin >13.1 mg/dl
      4. Minimal risk transcutaneous Bilirubin <9 mg/dl
    9. Age 60 hours of life
      1. High risk Infant: Serum Bilirubin >9.6 mg/dl
      2. Intermediate risk Infant: Serum Bilirubin >12.7 mg/dl
      3. Low risk Infant: Serum Bilirubin >15.2 mg/dl
      4. Minimal risk transcutaneous Bilirubin <10 mg/dl
    10. Age 72 hours of life
      1. High risk Infant: Serum Bilirubin >11.2 mg/dl
      2. Intermediate risk Infant: Serum Bilirubin >13.4 mg/dl
      3. Low risk Infant: Serum Bilirubin >16 mg/dl
      4. Minimal risk transcutaneous Bilirubin <12.5 mg/dl
    11. Age 84 hours of life
      1. High risk Infant: Serum Bilirubin >11.6 mg/dl
      2. Intermediate risk Infant: Serum Bilirubin >14.7 mg/dl
      3. Low risk Infant: Serum Bilirubin >16.7 mg/dl
    12. Age 96 hours of life
      1. High risk Infant: Serum Bilirubin >12.4 mg/dl
      2. Intermediate risk Infant: Serum Bilirubin >15.2 mg/dl
      3. Low risk Infant: Serum Bilirubin >17.4 mg/dl
    13. Age 108 hours of life
      1. High risk Infant: Serum Bilirubin >12.9 mg/dl
      2. Intermediate risk Infant: Serum Bilirubin >15.5 mg/dl
      3. Low risk Infant: Serum Bilirubin >17.6 mg/dl
    14. Age 120 hours of life
      1. High risk Infant: Serum Bilirubin >13.3 mg/dl
      2. Intermediate risk Infant: Serum Bilirubin >15.8 mg/dl
      3. Low risk Infant: Serum Bilirubin >17.7 mg/dl
    15. Age 132 hours of life
      1. High risk Infant: Serum Bilirubin >13.2 mg/dl
      2. Intermediate risk Infant: Serum Bilirubin >15.6 mg/dl
      3. Low risk Infant: Serum Bilirubin >17.5 mg/dl
    16. Age 144 hours of life
      1. High risk Infant: Serum Bilirubin >13.2 mg/dl
      2. Intermediate risk Infant: Serum Bilirubin >15.3 mg/dl
      3. Low risk Infant: Serum Bilirubin >17.3 mg/dl
  4. Interpretation: Normal Total Bilirubin in Newborns
    1. General
      1. Normal Increase <5 mg/dl/day (<0.5 mg/dl/hour)
      2. Conjugated Bilirubin (Direct) fraction <2 mg/dl
    2. Term Infant
      1. Peaks: 12.9 at 3 to 4 days of life
      2. Resolves at 4 to 7 days of life
    3. Preterm Infant
      1. Peaks: 15.0 at 5 to 7 days
      2. Resolves at 10 to 14 days of life
    4. Exagerated Physiologic Jaundice
      1. Peaks 17.0 at age 6 to 8 days of life
    5. Early-Onset Breast Milk Jaundice
      1. Same course as exaggerated physiologic Jaundice
      2. Total Bilirubin peaks < 17 mg/dl by day 4 of life
    6. Late-Onset Breast Milk Jaundice
      1. Bilirubin peaks between day of life 6 to 14 of life
      2. Total Bilirubin often 12 to 20 mg/dl
      3. Hyperbilirubinemia may persist 2-3 months
  5. References
    1. Ip (2004) Pediatrics 114(1): e130-53 [PubMed]
    2. Bhutani (1999) Pediatrics 103:6-14 [PubMed]
    3. Varvarigou (2009) Pediatrics 124(4): 1052-9 [PubMed]

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