Neonatal jaundice: a critical review of the role and practice of bilirubin analysis

Ann Clin Biochem 2008;45:452-462
© 2008 Association for Clinical Biochemistry


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Review Article

Jean M Kirk

Department of Paediatric Biochemistry/Haematology, Royal Hospital for Sick Children, Sciennes Road, Edinburgh EH9 1LF, UK

Email: Jean.Kirk{at}

Neonatal jaundice is common, and usually harmless, because of physiological jaundice or breast-feeding. In some neonates unconjugated bilirubin concentration, coupled with other risk factors, is sufficient to allow free bilirubin to cross the blood-brain barrier and cause kernicterus. Another subgroup of infants is jaundiced because of elevated conjugated bilirubin; a marker for a number of pathological conditions. Bilirubin measurement must identify those infants at risk. Transcutaneous bilirubin measurement is increasingly used in healthy infants, especially before early discharge or at home, to assess the need for laboratory bilirubin measurement. Transcutaneous measurements are not covered by laboratory quality assessment schemes. Guidelines on management of neonatal jaundice utilize age in hours and other risk factors to define bilirubin action thresholds, which may be as low as 100 µmol/L for sick premature infants, whereas early discharged babies may only present after bilirubin concentrations are extremely high. Hence, there is a requirement for accurate total bilirubin measurement from <100 to >500 µmol/L, with sufficientprecision to assess the rate of bilirubin change with time.Babies presenting with late jaundice always require conjugatedbilirubin measurement. It is of concern that many total anddirect bilirubin automated kit methods suffer from haemolysisinterference, while use of in-house methods or modificationof commercial methods has virtually disappeared. External qualityassessment has a vital role in providing data on different methods’performance, including accuracy, precision and susceptibilityto interference. Laboratories should consider whether theiradult bilirubin methods are suitable for neonates.

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