Prediction of early neonatal hyperbilirubinemia using 24-hour serum bilirubin level

Objective: To evaluate the predictive value of TSB=6 mg/dl at 24±6 hours of age in identifying those infants belonging to Bihar and border areas of Nepal who would not develop hyperbilirubinemia subsequently. Methods: Serum bilirubin was estimated for all enrolled cases within 18 to 30 hour of life spectrophotometrically using twin Beam method. The babies were then followed up clinically by 2 observers for the appearance and progression of jaundice every 12 hour till discharge from the department of obstetrics and gynaecology and were then admitted with their mothers in step down of NICU. Here they were followed up daily upto fifth day of life. TSB estimation was repeated if the clinical assessment of jaundice was more than 10 mg/dl by any observer using Kramers Rule. Hyerbilirubinemia was defined as TSB level 12 mg/dl between 24 to 48 hour of life 15 mg/dl between 48 to 72 hour of life and 17 mg/dl beyond 72 hours of life. Results: A total of 152 neonates were enrolled in the study. Of these, 23 neonates (i.e., 15.13%) developed hyperbilirubinemia. Sensitivity of TSB >6mg/dl at 24+6 hours in identifying those who will develop hyperbilirubinemia was 91.3%. Specificity was 76.74%.Positive predictive value was 41.2%. Negative predictive value was 98%. Therefore the test is useful in identifying the infants who are unlikely to develop hyperbilirubinemia. Conclusion: Incidence of hyperbilirubinemia in healthy term and near term babies is 15.23%. TSB at 24+6 hours