Predictors of significant jaundice in late preterm infants.

OBJECTIVES: To study (i) the incidence and course of jaundice, and (ii) the predictors of significant jaundice in late preterm infants.

DESIGN: Prospective analytical study.

SETTING: Urban perinatal center.

PATIENTS: Inborn late preterm infants (post menstrual age of 34 0/7 to 36 6/7 weeks).

METHODS: Infants were followed till day 14 of life or till onset of significant jaundice. Relevant maternal, perinatal and neonatal variables were prospectively recorded. Transcutaneous bilirubin (TcB) was measured in each infant twice daily for the first 48 hours of life.

OUTCOMES: Significant jaundice defined as requirement of phototherapy/exchange transfusion as per hour specific total serum bilirubin (TSB) nomogram of AAP guidelines.

RESULTS: 216 infants were enrolled, of which 123 (57%) had significant jaundice. 36% of the jaundiced infants had TSB greater than 15 mg/dL. The mean duration of onset of significant jaundice was 61 ± 32 hours. The mean duration of phototherapy was 49 ± 26 hours. Large for gestation, lower gestational age, birth trauma and previous sibling with jaundice predicted severe jaundice. TcB measured at 24-48 hrs was a better predictor of significant jaundice with onset after 48 hrs than clinical risk factors.

CONCLUSION: There is a high incidence of significant jaundice in late preterm infants. TcB measured at 24-48 hrs of life better predicts significant jaundice after 48 hours of life, in comparison with clinical risk factors.