Total and Fractionated Bilirubin during the First Week in the Neonatal Intensive Care Unit

Abstract

Background. Fractionated bilirubin requires more blood (0.6 ml) than total bilirubin alone (0.2 ml). Our focus during the first week in the Neonatal Intensive Care Unit (NICU) is on prevention of Bilirubin Induced Neurologic Dysfunction and kernicterus, which do not require fractionation. We wanted to determine the benefit of knowing fractionated bilirubin in the first week. Methods. In this retrospective study, data were obtained from the first week for 1202 NICU inborn admissions. Results. Direct bilirubin was more than 2.0 mg/dl in only six infants (0.6%). Five had multisystem injury from hypoxic ischemic events. One also had congenital cytomegalovirus and another had a postoperative liver hematoma. Weekly multichem profiles would have detected these abnormalities. No specific therapy was initiated for any of these infants. Conclusions. Converting to total bilirubin alone would not alter treatment, but could reduce iatrogenic blood loss by 2.4 ml per infant.