Abstract
Objective:
We assessed the relative contributions of increased bilirubin production (indexed by end-tidal carbon monoxide (CO) concentrations, corrected for ambient CO (ETCOc)) to hour-specific total bilirubin (TB) levels in healthy late preterm and term newborns.
Study design:
Post hoc analyses of concurrent ETCOc and TB (at 30±6 h of age) and follow-up TB levels at age 96±12 h and up to 168 h after birth were performed in a cohort of 641 term and late preterm infants.
Results:
Increased bilirubin production (hour-specific ETCOc ⩾1.7 p.p.m. at age 30±6 h) was noted in ~80%, 42% and 32% of infants in the high-, intermediate- and low-risk TB zones, respectively. One infant with TB <40th percentile and ETCOc <1.7 p.p.m. developed TB ⩾95th percentile at age 168 h, probably due to decreased bilirubin elimination.
Conclusions:
Infants in the high-risk quartile of the hour-specific bilirubin nomogram have a higher mean bilirubin production. Infants with TB levels ⩾95th percentile without increased bilirubin production have impaired bilirubin elimination.
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Jaundice Multinational Study Group
David K Stevenson, Ronald J Wong, Hendrik J Vreman and James R MacMahon (Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA); Avroy A Fanaroff (Department of Neonatology, Rainbow Babies’ and Children’s Hospital, Cleveland, OH, USA); M Jeffrey Maisels (Department of Pediatrics, Wm. Beaumont Hospital, Royal Oak, MI, USA); Betty WY Young (Department of Pediatrics, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China); Chap Y Yeung (Department of Pediatrics, Queen Mary Hospital/Tsan Yuk Maternity Hospital, Hong Kong, China); Daniel S Seidman and Rena Gale (Department of Pediatrics, Bikur Cholim Hospital, Jerusalem, Israel); William Oh (Department of Pediatrics, Women’s and Infants Hospital, Providence, RI, USA); Vinod K Bhutani and Lois H Johnson (Section on Newborn Pediatrics, Pennsylvania Hospital, Philadelphia, PA, USA); Michael Kaplan and Cathy Hammerman (Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel); Hajime Nakamura (Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan).
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Bhutani, V., Wong, R., Vreman, H. et al. Bilirubin production and hour-specific bilirubin levels. J Perinatol 35, 735–738 (2015). https://doi.org/10.1038/jp.2015.32
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DOI: https://doi.org/10.1038/jp.2015.32
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