Prognostic value of direct bilirubin in neonatal hyperbilirubinemia

Objective To determine the prognostic value of indirect and direct hyperbilirubinemia in neonates with jaundice. Methods A cohort of 92 consecutive neonates reporting with hyperbilirubinemia to a tertiary care center were followed up till well and discharged, or, till death to assess risk and rate of mortality. Results The baseline median values of total, direct and indirect bilirubin in the cohort of 21.8, 1.6 and 18.6 mg/dl, respectively, were used as cut-offs for high and low levels. Using survival analyses i.e. Kaplan-Meier plots, logrank tests and multivariate Cox proportional hazards regression models to adjust for other strong predictors such as receipt of breastfeeding, being small for gestational age (SGA) and exchange transfusion, high direct bilirubin (≥ median value of 1.6 mg/dl) was independently associated with a higher and faster mortality. Conclusion This study showed that direct bilirubin has independent and additive prognostic value and due attention should be given to newborns with raised levels.