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Bilirubin Concentrations in Jaundiced Neonates with Conjunctival Icterus
1Division of Newborn Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA.
Objectives:
To assess the total serum bilirubin (TSB) levels at which conjunctival icterus is observed in neonates of ≥34 weeks gestation during the first week of life.
Study Design:
Two convenience samples of neonates were examined for conjunctival icterus within 4 hours of TSB measurements. A concurrent assessment of cephalopedal cutaneous icterus was performed and the TSB characterized using the Bhutani hour-specific risk zone nomogram.
Results:
Two hundred forty neonates were studied of which 76 had conjunctival icterus. Conjunctival icterus was always accompanied by cutaneous jaundice to at least the chest and more often than not a TSB >14.9 mg/dL (255 umol/L) consistently in the 76th%-95th% to >95th% range on the Bhutani nomogram. Only a few infants with TSB in the range of 10-14.9 mg/dL (171-255 umol/L) had conjunctival icterus.
Conclusions:
Conjunctival icterus was observed in a subset of jaundiced neonates and associated with elevated hour-specific TSB levels frequently >95th% on the Bhutani nomogram. Conjunctival icterus is a sign of clinically relevant hyperbilirubinemia that merits a TSB measurement and evaluation of the infant.
