Neonatal Bilirubin

Aka: Neonatal Bilirubin, Bilirubin in Newborns

II. Resources

  1. Bilirubin Tool
    1. http://www.bilitool.com

III. 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

IV. 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

V. 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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