Hyperbilirubinemia screening and treatment in neonates born prior to 35 weeks of gestation
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Updated: May 8, 2026
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Published on: August 24, 2011
S Khan1, H Coo2, F Khurshid2
1Faculty of Health Sciences, School of Medicine, Queen's University, Kingston, ON, Canada.
Insights
Screening for neonatal hyperbilirubinemia in early preterm infants needs improved guidelines. Current total serum bilirubin (TSB) measurement timing is often ineffective, increasing risks and healthcare costs.
Area of Science:
- Neonatal Medicine
- Pediatrics
- Clinical Research
Background:
- Current neonatal hyperbilirubinemia screening guidelines are for infants born at ≥35 weeks gestation.
- The efficacy of these guidelines for infants born earlier remains unexamined.
Purpose of the Study:
- To investigate hyperbilirubinemia screening practices and phototherapy use in early preterm infants (born <35 weeks gestation).
- To evaluate the timing and necessity of total serum bilirubin (TSB) measurements and phototherapy initiation within the first six days of life.
Main Methods:
- Retrospective chart review of 193 infants born <35 weeks gestation admitted to a tertiary NICU.
- Extraction of TSB measurements and phototherapy treatment decisions at 12-hour intervals for the first six days of life.
Main Results:
- 45% of infants received phototherapy, with higher rates in the earliest preterm groups (37% for <28 weeks vs. 5.7% for 33-34 weeks).
- TSB measurements were frequently performed to assess phototherapy need, with 605 of 1006 measurements used for this purpose.
Conclusions:
- TSB measurement timing is often suboptimal for early preterm infants, potentially leading to complications from phlebotomy and inefficient resource use.
- Development of specific guidelines for hyperbilirubinemia screening in early preterm infants is necessary to optimize care and resource allocation.
Background:
Guidelines on when to screen for neonatal hyperbilirubinemia apply to infants born at 35 weeks or later of gestation. It is unknown whether infants born earlier would benefit from similar guidelines. Our objective was to examine hyperbilirubinemia screening and phototherapy prescription among early preterm infants during the first 6 days of life.
Methods:
We reviewed the charts of 193 infants born prior to 35 weeks of gestation who were admitted to a tertiary care NICU in Southeastern Ontario in 2018-2019. Information on total serum bilirubin (TSB) measurements over each 12-hour interval during the first six days of life and the treatment decision (no treatment, initiate, continue, or stop phototherapy) was extracted. We also examined what proportion of infants were prescribed phototherapy during each 12-hour interval.
Results:
Of 1006 TSB measurements performed over the first 6 days of life, 605 were done to determine whether phototherapy should be initiated. Treatment was prescribed in 275 instances (45%). A higher proportion of infants born prior to 28 weeks of gestation required phototherapy in the first 12 hours of life (37%) compared to those born at 28-32 weeks (20%) and 33-34 weeks (5.7%).
Conclusions:
Our results suggest that TSB measurements are often poorly timed to detect treatment need in infants born prior to 35 weeks of gestation. This unnecessarily increases the risk of complications from phlebotomy and is an ineffective use of health care resources. There is a need to develop guidelines to optimize hyperbilirubinemia screening among early preterm infants.
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