Direct bilirubin measurements in jaundiced term newborns. A reevaluation
T. B. Newman, S. Hope and D. K. Stevenson
Department of Pediatrics, School of Medicine, University of California, San Francisco 94143.
To investigate the usefulness of measuring direct bilirubin in jaundiced
term newborns, we reviewed the outcome of 5255 such measurements on 2877
term (37 weeks' gestation) newborns in two hospitals. Direct bilirubin
tests were ordered 15 times as often per infant at the University of
California, San Francisco, as at Stanford (Calif) University, and the
reported results were more than twice as high. In most of the 149 infants
with high (greater than 95th percentile) direct bilirubin levels, the high
levels remained unexplained (52% of cases) or were due to apparent
laboratory errors (21% of cases). Forty infants (27%) had conditions
sometimes associated with high direct bilirubin levels. Elevation of direct
bilirubin levels contributed to the diagnosis in only four of these
infants. All had minor laboratory abnormalities that resolved
spontaneously. Because of their low yield and poor specificity, direct
bilirubin tests are seldom helpful in evaluating jaundice in term newborns.
