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Hour-Specific Total Serum Bilirubin Percentiles for Infants Born at 29-35 Weeks' Gestation

Thivia Jegathesan1,2, Joel G Ray1,3,4, Vinod K Bhutani5

  • 1Institute of Medical Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.

Neonatology
|October 28, 2021
PubMed

Insights

This study establishes hour-specific total serum bilirubin (TSB) percentile cut-points for preterm infants, aiding in hyperbilirubinemia monitoring. These novel nomograms provide crucial data for clinical decision-making in neonatal care.

Area of Science:

  • Neonatal Medicine
  • Pediatric Endocrinology

Background:

  • Preterm infants are highly susceptible to hyperbilirubinemia, necessitating vigilant monitoring.
  • Current clinical practice lacks established hour-specific total serum bilirubin (TSB) percentile cut-points for preterm neonates.
  • This deficiency hinders timely and accurate assessment of hyperbilirubinemia risk prior to phototherapy initiation.

Purpose of the Study:

  • To develop and present hour-specific TSB percentile nomograms for preterm infants.
  • To provide a data-driven tool for describing bilirubin levels in relation to gestational age and postnatal age.
  • To inform clinical management and research regarding hyperbilirubinemia in this vulnerable population.

Main Methods:

  • A retrospective cohort study was conducted involving 2,549 preterm infants (290/7-356/7 weeks' gestation) across three NICUs in Ontario, Canada.
  • Data from 6,143 pre-treatment TSB levels were collected between January 2013 and June 2017.
  • Hour-specific TSB percentiles were generated using quantile regression, stratified by gestational age and phototherapy status.

Main Results:

  • Hour-specific TSB percentiles at birth, 75th, and 95th were established for the overall cohort.
  • Distinct percentile values were reported for infants who received phototherapy versus those who did not.
  • Significant differences in TSB percentiles were observed based on degree of prematurity (29-32 weeks vs. 33-35 weeks' gestation).

Conclusions:

  • The developed hour-specific TSB percentile nomograms offer a novel method for characterizing bilirubin levels in preterm newborns.
  • These nomograms may assist in the standardized description and interpretation of TSB levels.
  • Further research is warranted to validate and integrate these pre-treatment TSB level findings into routine clinical practice.
Abstract

Keywords:
BilirubinHyperbilirubinemiaPhototherapyQuantile regression

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