This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Pediatrics  • Neonatology and Infant Care  • Review  • Hematology/ Hematologic Malignancies  • Hematology, Other  • Alert me on articles by topic  Social Bookmarking   What's this?

A Systematic Review of Population Differences and Analysis of Bilirubin Kinetics

Daniele De Luca, MD; Gregory L. Jackson, MD, MBA; Ascanio Tridente, MD, MRCP; Virgilio P. Carnielli, MD, PhD; William D. Engle, MD

Arch Pediatr Adolesc Med. 2009;163(11):1054-1059.

Objectives  To compare available nomograms in the literature defining trends in bilirubin levels across populations with different risk factor profiles and to study a mathematical bilirubin kinetics model describing the natural course of jaundice and the bilirubin rate of rise needed to cross percentile curves.

Data Sources  We searched PubMed for publications between March 1999 and March 2009 that created transcutaneous nomograms. We performed the same search among abstracts presented in the past 2 years at meetings of the Pediatric Academic Societies or the European Society for Paediatric Research.

Study Selection  Inclusion criteria were gestational age of at least 35 weeks among study subjects, the use of an electronic transcutaneous bilirubinometer, and creation of a nomogram based on hour-specific bilirubin values. Four articles met the selection criteria.

Data Extraction  Jaundice risk factors were analyzed, and raw data were analyzed using nonlinear regression to describe trends in bilirubin levels and kinetics. The bilirubin exaggerated rate of rise needed to cross percentile curves was calculated.

Data Synthesis  Significant differences in bilirubin values exist across populations, and there is substantial variability in rates of rise. Hispanic neonates demonstrate higher rates of rise and later plateaus. Bilirubin rates of rise tend to plateau and become null (equilibrium between bilirubin production and elimination) at about 96 hours of life. Rates of rise needed to cross percentile curves decrease over time but are lower (approximately 0.11 mg/dL/h [to convert bilirubin level to micromoles per liter, multiply by 17.104]) in the first 48 hours of life than previously thought.

Conclusions  Transcutaneous bilirubin levels plateau and then decrease after about 96 hours of life in healthy neonates, with some differences across populations. A bilirubin rate of rise higher than in the previous period implies that bilirubin production exceeds elimination and indicates high risk for subsequent hyperbilirubinemia in neonates.

Author Affiliations: Division of Neonatology, Institute of Mother and Child Health, "G. Salesi" Women's and Children's Hospital, Polytechnical University of Marche, Ancona, Italy (Drs De Luca and Carnielli); Division of Neonatal Medicine, Department of Pediatrics, The University of Texas Southwestern Medical Center, Dallas (Drs Jackson and Engle); and Sheffield Teaching Hospitals, National Health Service Foundation Trust, Sheffield (Dr Tridente), and Division of Pediatric Nutrition, Great Ormond Street Hospital for Children, Imperial College, London (Dr Carnielli), England.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?