Affiliations: Queen Elizabeth Hospital, Bridgetown, Barbados | Department of Pediatrics, UMDNJ-Robert Wood Johnson
Medical School, New Brunswick, NJ, USA
Note: [] Corresponding author: Anna Petrova MD, PhD, MPH, Department of
Pediatrics, MEB 236, UMDNJ-Robert Wood Johnson Medical School, One Robert Wood
Johnson Place, New Brunswick, NJ 08903-0019, USA. Tel.: +1 732 235 7036; Fax:
+1 732 235 7075; E-mail: [email protected]
Abstract: Objective: To determine the percentile distribution of the
pre-discharge total serum bilirubin (TSB) in a culturally diverse cohort of
healthy term newborns. Study Design: Pre-discharge TSB values obtained
during the first 96 hours of life in term newborn infants with birth weight
⩾ 2,500 grams and no evidence of isoimmunization and hyperbilirubinemia
(prior to and after discharge) were studied with respect to race/ethnic
background and gender. The population's mean pre-discharge TSB levels and TSB
percentile distribution (40th, 75th, and 95th) of the TSB values at 12-hour
intervals were identified and compared with the American Academy of Pediatrics
(AAP) recommended TSB nomogram. Descriptive, factorial ANOVA and multivariate
regression statistics were used to analyze the results. Results: The
study included 751 healthy newborns of which 215 (28.6%) were white, 91
(12.1%) were black, 303 (40.3%) were Hispanic, and 142 (18.9%) were
Asian. We found that the pre-discharge TSB values in these term healthy
newborns were significantly associated with the age at TSB testing, weight loss
and exclusive breastfeeding but not race/ethnicity and gender. The TSB values
were mainly in the 40th percentile zone. The numbers of TSBs in the 95th
percentile zone varied from 3.2% to 6.4% at the different time points of
measurement. After 48 hours of age, there was a discrepancy of 1 to 2 mg/dL as
compared to the AAP recommended TSB nomogram. Conclusion: There is race/ethnicity and gender uniformity in the pre-discharge TSB levels of term
healthy newborns. The observed discrepancy with the reference data suggests the
need for determination of population-specific normal pre-discharge TSB values
in each hospital setting for the effective post-discharge surveillance of all eligible infants.
Keywords: Total serum bilirubin, percentiles, race, ethnicity
