Predictive value of the 24-hour bilirubin in the development of significant hyperbilirubinemia among Filipino term (≥37 weeks gestational age) infants: a prospective multi-center study.

Abstract

Hyperbilirubinemia is the most common neonatal morbidity. In the Philippines, neonates are at a higher risk for developing significant hyperbilirubinemia (SH) due to belonging to the East Asian race and high incidence of G6PD deficiency. The aim of this study is to determine an effective plasma bilirubin cut-off value at the 24^th hour of life (HOL) in Filipino term infants, associated with the development of significant hyperbilirubinemia at the 72^nd HOL. A prospective multicentric cohort involving 21 medical centers nationwide recruited 2099 mother-infant dyads with 1688 completing the 72^nd HOL follow-up. Using a point-of-care tool (Bilistick 2.0), plasma bilirubin was determined at the 24^th and 72^nd HOL. The 24^th-hour bilirubin level (≥ 7.5 mg/dL) can accurately predict the development of SH at the 72^nd HOL. Other significant risk factors include decreased urine and stool frequencies in the first 3 days as well as jaundice noted in the first 24 hours of life. For Filipino infants, the 24^th HOL bilirubin level of 7.5 mg/dL is a good cut-off level to predict subsequent significant hyperbilirubinemia. Pre-discharge bilirubin screening programs in the Philippines should consider the 24^th HOL bilirubin as well as clinical risk factors to effectively identify at risk neonates. Significant hyperbilirubinemia is an important public health problem in the Philippines. Total bilirubin determination performed at the 24^th hour of life can adequately predict development of significant hyperbilirubinemia at the 72^nd hour of life. A 24 h bilirubin level of ≥ 7.5 mg/dL can be used as a cut-off value to identify Filipino infants at risk of developing significant hyperbilirubinemia. The Bilistick 2.0 device is a reliable tool to determine total bilirubin among Filipino infants. Establishment of a pre-discharge bilirubin screening program utilizing the 24 h bilirubin level plus risk factors (inadequate breastmilk intake, blood incompatibility, late preterm, bruising) is recommended to identify at risk Filipino infants.