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A Reevaluation

Thomas B. Newman, MD, MPH; Sylvia Hope, PhD; David K. Stevenson, MD

Am J Dis Child. 1991;145(11):1305-1309.

Abstract
• 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 (>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.

(AJDC. 1991;145:1305-1309)

Author Affiliations
From the Division of General Pediatrics, Department of Pediatrics (Drs Newman and Hope), the Division of Clinical Epidemiology, Department of Epidemiology and Biostatistics (Dr Newman), and the Robert Wood Johnson Clinical Scholars Program (Dr Newman), School of Medicine, University of California, San Francisco, and the Division of Neonatology, Department of Pediatrics, School of Medicine, Stanford (Calif) University (Dr Stevenson).

Footnotes
Accepted for publication May 13, 1991.

Presented at the 31st Annual Meeting of the Ambulatory Pediatric Association, New Orleans, La, April 29, 1991.

Reprint requests to the Division of General Pediatrics, Box 0374, University of California, San Francisco, CA 94143 (Dr Newman).

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ABSTRACT  

DIRECT BILIRUBIN MEASUREMENTS ARE UNNECESSARY IN JAUNDICED NEWBORNS
JWatch General 1991;1991:3-3.
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