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Rate of rise of total serum bilirubin in very low birth weight preterm infants



To assess the postnatal rate of rise (ROR) of total serum bilirubin (TSB) in very low birth weight (VLBW) preterm infants, to determine risk factors associated with a rapid rise (>90th percentile), and to compare ROR and hour-specific TSB at postnatal 12–48 h with data of term infants retrieved from the literature.


Retrospective analysis of 2430 routine TSB concentrations obtained between birth and initiation of phototherapy in 483 VLBW infants.


TSB increased by a median (interquartile range) ROR of 0.15 (0.11–0.19) mg/dL/h. The 50th percentile of TSB was below the 40th percentile of (near-)term counterparts at 12–48 h. TSB ROR correlated with the age at initiation (RS = −0.687; p < 0.001) and the duration (RS = 0.444; p < 0.001) of phototherapy. ROR >90th percentile (>0.25 mg/dL/h) was associated with lower gestational ages [27.2 (25.4–29.3) vs. 28.4 (26.4–30.4) weeks], lower birth weights [978 (665–1120) vs. 1045 (814–1300) g], and lower 5-min Apgar scores [7 (7–8) vs. 8 (7–9)].


ROR of TSB is an indicator for early and prolonged phototherapy. While hour-specific TSB and ROR at 12–48 h are lower than those reported for (near-)term infants, TSB appears to rise more rapidly in infants with low gestational age, low birth weight, and low 5-min Apgar score.

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We thank Petra Blank and Regina Nagel (secretaries), Jessica Blank (study assistant), Frank Ording (quality system records), and Anita Pierschke (functional diagnostics) for their helpful assistance in this study.

Author contributions

S.H. designed the data collection instruments, collected data, carried out the initial analyses, drafted the initial manuscript, and reviewed and revised the manuscript. C.B. conceptualized and designed the study, interpreted the data, and reviewed and revised the manuscript critically. G.S. and B.M. coordinated and supervised data collection, and carried out the final analyses and interpretation. M.B. conceptualized and designed the study, coordinated and supervised data collection and interpretation, and reviewed and revised the manuscript. Final approval of the version is to be published. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

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Competing interests

The authors declare no competing interests.

Correspondence to Monika Berns.

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