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  • Original Article
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Prediction of Hyperbilirubinemia in Near-Term and Term Infants

Journal of Perinatology volume 21, pages S63–S72 (2001)Cite this article

Abstract

OBJECTIVE: 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.

METHODS: 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.

RESULTS: 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 ≥95th percentile. When infants with STB ≥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.

CONCLUSIONS: 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.

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Acknowledgements

We thank Ann Olthof, RN, and Petra A. Swidler, MD (Lucile Salter Packard Children's Hospital), Sue Bergant, RN (Rainbow Babies' and Children's Hospital), Elizabeth Kring, RN (William Beaumont Hospital), Dr Ka-Yin Wong (Queen Mary and Tsan Yuk Maternity Hospitals), Angelita Hensman, RN (Women and Infants Hospital), and Christine Dalin, RN (Pennsylvania Hospital). Advice on protocol decision and statistical analysis from Professor B. W. Brown is gratefully acknowledged.

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Authors and Affiliations

  1. Department of Pediatrics, Lucile Salter Packard Children's Hospital, Stanford, CA, USA

    David K Stevenson MD, Ronald J Wong BA, Hendrik J Vreman PhD & James R MacMahon MD

  2. Department of Neonatology, Rainbow Babies' and Children's Hospital, Cleveland, OH, USA

    Avroy A Fanaroff MB, BCh

  3. Department of Pediatrics, William Beaumont Hospital, Royal Oak, MI, USA

    M Jeffrey Maisels MB, BCh

  4. Department of Paediatrics, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China

    Betty WY Young MD

  5. Department of Paediatrics, Queen Mary Hospital/Tsan Yuk Maternity Hospital, Hong Kong, China

    Chap Y Yeung MD

  6. Departments of Neonatology and Obstetrics and Gynecology, Bikur Cholim Hospital, Jerusalem, Israel

    Daniel S Seidman MD & Rena Gale MD

  7. Department of Pediatrics, Women and Infants Hospital, Providence, RI, USA

    William Oh MD

  8. Department of Pediatrics, Pennsylvania Hospital, Philadelphia, PA, USA

    Vinod K Bhutani MD & Lois H Johnson MD

  9. Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel

    Michael Kaplan MB, BCh & Cathy Hammerman MD

  10. Department of Pediatrics, University of Kobe, Kobe, Japan

    Hajime Nakamura MD

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  1. David K Stevenson MD
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Additional information

This study was supported by a grant from Natus Medical (San Carlos, CA) and the H. M. Lui Research Fund.

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Stevenson, D., Fanaroff, A., Maisels, M. et al. Prediction of Hyperbilirubinemia in Near-Term and Term Infants. J Perinatol 21 (Suppl 1), S63–S72 (2001). https://doi.org/10.1038/sj.jp.7210638

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