{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T07:23:57Z","timestamp":1789025037609,"version":"build-2803163510"},"reference-count":27,"publisher":"American Academy of Pediatrics (AAP)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2002,4,1]]},"abstract":"<jats:p>Objective. In the era of early discharge of newborns from the hospital, newborns with ABO incompatibility are at especially greater risk for developing a subsequent significant hyperbilirubinemia because some of these infants also may present with some degree of ABO isoimmune disease. In this study, we aimed to determine prospectively the critical serum total bilirubin level to predict significant hyperbilirubinemia and severe hemolytic disease in healthy term newborns with ABO incompatibility based on a serum bilirubin measurement made at a postnatal age at which all newborns are at the hospital before discharge and at which any therapeutic intervention, if necessary, could be started as early as possible.<\/jats:p>\n                  <jats:p>Methods. A total of 136 healthy term newborns with ABO (O-A or O-B) blood group incompatibility were followed prospectively with daily serum total bilirubin measurements for the first 5 days of life. Newborns with serum total bilirubin levels of \u22655 mg\/dL and an increase in serum total bilirubin concentration of &amp;gt;0.5 mg\/dL\/h in the first 24 hours, \u226512 mg\/dL on day 2, \u226515 mg\/dL on day 3, and \u226517 mg\/dL on days 4 and 5 were defined to have significant hyperbilirubinemia and were started on phototherapy treatment. Additional treatment modalities, including intense phototherapy, intravenous immunoglobulin treatment, and exchange transfusion, were used when serum bilirubin concentrations exceeded 20 mg\/dL or increased by &amp;gt;1 mg\/dL\/h despite a phototherapy treatment of at least 4 hours. The additional assessment of the predictive ability of the sixth-hour serum total bilirubin value in determining the development of significant hyperbilirubinemia was made on the basis of the placement of any of the first 5 days\u2019 serum bilirubin measurements in the \u226590th percentile of the study population. On the basis of the percentile tracks constructed from the 10th, 35th, 50th, 60th, and 90th percentiles of serum total bilirubin values, a nomogram demonstrating the 3 percentile tracks as risk zone demarcators with divided risk zones was produced.<\/jats:p>\n                  <jats:p>Results. Twenty-nine newborns (21.3%) had significant hyperbilirubinemia. There were significant differences between the newborns who did and the newborns who did not develop significant hyperbilirubinemia with respect to the reticulocyte count (4.39 \u00b1 3.46% vs 2.95 \u00b1 1.63) and the presence of a direct antiglobulin test positivity (6 of 23 vs 0 of 107) and a sibling with neonatal jaundice (6 of 23 vs 5 of 102). A mean serum bilirubin level of \u22654 mg\/dL at the sixth hour of life was determined to have the highest sensitivity (86.2%) and negative predictive value (94.5%) and a positive predictive value of 39.7% to predict the newborns who would develop significant hyperbilirubinemia. At the mean serum bilirubin level of 6 mg\/dL, the sensitivity, specificity, and negative and positive predictive values were 100%, 91.5%, 100%, and 35.3%, respectively, in diagnosing 6 cases of severe ABO hemolytic disease. On the hour (age)-specific percentile-based nomogram, the zone above the 90th percentile was determined as high risk and that below the 35th percentile as low risk.<\/jats:p>\n                  <jats:p>Conclusions. The reticulocyte count, a positive direct antiglobulin test, and the presence of a sibling with neonatal jaundice were determined to be the good predictors for the development of significant hyperbilirubinemia and severe hemolytic disease of the newborn. A serum bilirubin measurement and the use of the critical bilirubin levels of 4 mg\/dL and 6 mg\/dL at the sixth hour of life will predict nearly all newborns who will have significant hyperbilirubinemia and those who will develop severe hemolytic disease of the newborn, respectively. An hour (age)-specific percentile-based nomogram can be used to predict which newborn is at high risk (\u226590th percentile), intermediate risk (35th\u201390th percentiles), and low risk (&amp;lt;35th percentile) for developing significant hyperbilirubinemia. The 35th and 90th percentile tracks, approximating the serum bilirubin levels of 3.3 mg\/dL and 6.5 mg\/dL at the sixth hour of life, respectively, can be used as safe risk demarcators in deciding about the time of discharge of ABO-incompatible newborns from the hospital.<\/jats:p>","DOI":"10.1542\/peds.109.4.e53","type":"journal-article","created":{"date-parts":[[2004,8,13]],"date-time":"2004-08-13T20:17:55Z","timestamp":1092428275000},"page":"e53-e53","source":"Crossref","is-referenced-by-count":70,"title":["An Early (Sixth-Hour) Serum Bilirubin Measurement Is Useful in Predicting the Development of Significant Hyperbilirubinemia and Severe ABO Hemolytic Disease in a Selective High-Risk Population of Newborns With ABO Incompatibility"],"prefix":"10.1542","volume":"109","author":[{"given":"S. U\u0308mit","family":"Sarici","sequence":"first","affiliation":[{"name":"Division of Neonatology, Department of Pediatrics, Hacettepe University Faculty of Medicine I\u0307hsan Dog\u0306ramaci Children\u2019s Hospital, Ankara, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Murat","family":"Yurdako\u0308k","sequence":"additional","affiliation":[{"name":"Division of Neonatology, Department of Pediatrics, Hacettepe University Faculty of Medicine I\u0307hsan Dog\u0306ramaci Children\u2019s Hospital, Ankara, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhittin A.","family":"Serdar","sequence":"additional","affiliation":[{"name":"Department of Clinical Biochemistry, GU\u0308lhane Military Medical Academy, Ankara, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olcay","family":"Oran","sequence":"additional","affiliation":[{"name":"Division of Neonatology, Department of Pediatrics, Hacettepe University Faculty of Medicine I\u0307hsan Dog\u0306ramaci Children\u2019s Hospital, Ankara, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"GU\u0308ls\u0327en","family":"Erdem","sequence":"additional","affiliation":[{"name":"Division of Neonatology, Department of Pediatrics, Hacettepe University Faculty of Medicine I\u0307hsan Dog\u0306ramaci Children\u2019s Hospital, Ankara, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"GU\u0308lsevin","family":"Tekinalp","sequence":"additional","affiliation":[{"name":"Division of Neonatology, Department of Pediatrics, Hacettepe University Faculty of Medicine I\u0307hsan Dog\u0306ramaci Children\u2019s Hospital, Ankara, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S\u0327ule","family":"Yig\u0306it","sequence":"additional","affiliation":[{"name":"Division of Neonatology, Department of Pediatrics, Hacettepe University Faculty of Medicine I\u0307hsan Dog\u0306ramaci Children\u2019s Hospital, Ankara, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2002,4,1]]},"reference":[{"key":"2021121006194234800_R1","doi-asserted-by":"crossref","unstructured":"Maisels MJ, Kring E. Length of stay, jaundice, and hospital readmission. Pediatrics.1998;101:995\u2013998","DOI":"10.1542\/peds.101.6.995"},{"key":"2021121006194234800_R2","doi-asserted-by":"crossref","unstructured":"Lee K-S, Perlman M, Ballantyne M. Association between duration of neonatal hospital stay and readmission rate. J Pediatr.1995;127:758\u2013766","DOI":"10.1016\/S0022-3476(95)70170-2"},{"key":"2021121006194234800_R3","doi-asserted-by":"crossref","unstructured":"Soskolne EL, Schumacher R, Fyock C, Young ML, Schork A. The effect of early discharge and other factors on readmission rates of newborns2. Arch Pediatr Adolesc Med.1996;150:373\u2013379","DOI":"10.1001\/archpedi.1996.02170290039006"},{"key":"2021121006194234800_R4","doi-asserted-by":"crossref","unstructured":"Liu LL, Clemens CJ, Shay DK, Davis RL, Novack AH. The safety of newborn early discharge: the Washington State experience. JAMA.1997;278:293\u2013298","DOI":"10.1001\/jama.278.4.293"},{"key":"2021121006194234800_R5","doi-asserted-by":"crossref","unstructured":"Grupp-Phelan J, Taylor JA, Liu LL, Davis RL. Early newborn hospital discharge and readmission for mild and severe jaundice. Arch Pediatr Adolesc Med.1999;153:1283\u20131288","DOI":"10.1001\/archpedi.153.12.1283"},{"key":"2021121006194234800_R6","doi-asserted-by":"crossref","unstructured":"Seidman DS, Stevenson DK, Ergaz Z, Gale R. Hospital readmission due to neonatal hyperbilirubinemia. Pediatrics.1995;96:727\u2013729","DOI":"10.1542\/peds.96.4.727"},{"key":"2021121006194234800_R7","doi-asserted-by":"crossref","unstructured":"Braveman P, Egerter S, Pearl M. Early discharge of newborns and mothers: a critical review of the literature. Pediatrics.1995;96:716\u2013726","DOI":"10.1542\/peds.96.4.716"},{"key":"2021121006194234800_R8","doi-asserted-by":"crossref","unstructured":"Brown AK, Damus K, Kim MH, et al. Factors relating to readmission of term and near term neonates in the first two weeks of life. J Perinat Med.1999;27:263\u2013275","DOI":"10.1515\/JPM.1999.037"},{"key":"2021121006194234800_R9","doi-asserted-by":"crossref","unstructured":"Britton JR, Britton HL, Beebe SA. Early discharge of the newborn: a continued dilemma. Pediatrics.1994;94:291\u2013294","DOI":"10.1542\/peds.94.3.291"},{"key":"2021121006194234800_R10","doi-asserted-by":"crossref","unstructured":"Catz C, Hanson JW, Simpson L, Yaffe SJ. Summary of workshop: early discharge and neonatal hyperbilirubinemia. Pediatrics.1995;96:743\u2013745","DOI":"10.1542\/peds.96.4.743"},{"key":"2021121006194234800_R11","doi-asserted-by":"crossref","unstructured":"Conrad PD, Wilkering RB, Rosenberg AA. Safety of newborn discharge in less than 36 hours in an indigent population. Am J Dis Child.1989;143:98\u2013101","DOI":"10.1001\/archpedi.1989.02150130108026"},{"key":"2021121006194234800_R12","doi-asserted-by":"crossref","unstructured":"Alpay F, Sarici SU, Tosuncuk HD, Serdar MA, Inanc N, Gokcay E. The value of first-day bilirubin measurement in predicting the development of significant hyperbilirubinemia in healthy term newborns. Pediatrics.2000;106(2). Available at: http:\/\/www.pediatrics.org\/cgi\/content\/full\/106\/2\/e16","DOI":"10.1542\/peds.106.2.e16"},{"key":"2021121006194234800_R13","doi-asserted-by":"crossref","unstructured":"Bhutani VK, Johnson LH, Sivieri EM. Universal newborn bilirubin screening [abstract]. Pediatr Res.1997;41:191","DOI":"10.1203\/00006450-199704001-01152"},{"key":"2021121006194234800_R14","doi-asserted-by":"crossref","unstructured":"Seidman DS, Ergaz Z, Paz I, et al. Predicting the risk of jaundice in fullterm healthy newborns: a prospective population-based study. J Perinatol.1999;19(8, pt 1):564\u2013567","DOI":"10.1038\/sj.jp.7200274"},{"key":"2021121006194234800_R15","doi-asserted-by":"crossref","unstructured":"Bhutani VK, Johnson L, Sivieri EM. Predictive ability of a predischarge hour-specific serum bilirubin for subsequent significant hyperbilirubinemia in healthy term and near-term newborns. Pediatrics.1999;103:6\u201314","DOI":"10.1542\/peds.103.1.6"},{"key":"2021121006194234800_R16","unstructured":"Zipursky A, Bowman JM. Isoimmune hemolytic disease. In: Nathan DG, Oski FA, eds. Hematology of Infancy and Childhood. 4th ed. Philadelphia, PA: WB Saunders;1993:44\u201374"},{"key":"2021121006194234800_R17","doi-asserted-by":"crossref","unstructured":"American Academy of Pediatrics, Provisional Committee for Quality Improvement and Subcommittee on Hyperbilirubinemia. Practice parameter: management of hyperbilirubinemia in the healthy term newborn. Pediatrics.1994;94:558\u2013565","DOI":"10.1542\/peds.94.4.558"},{"key":"2021121006194234800_R18","doi-asserted-by":"crossref","unstructured":"Sarici SU, Alpay F, Unay B, Ozcan O, Gokcay E. Double versus single phototherapy in term newborns with significant hyperbilirubinemia. J Trop Pediatr.2000;46:36\u201339","DOI":"10.1093\/tropej\/46.1.36"},{"key":"2021121006194234800_R19","doi-asserted-by":"crossref","unstructured":"Alpay F, Sarici SU, Okutan V, Erdem G, Ozcan O, Gokcay E. High-dose intravenous immunoglobulin therapy in neonatal immune haemolytic jaundice. Acta Paediatr.1999;88:216\u2013219","DOI":"10.1111\/j.1651-2227.1999.tb01085.x"},{"key":"2021121006194234800_R20","doi-asserted-by":"crossref","unstructured":"Maisels MJ, Newman TB. Kernicterus in otherwise healthy, breast-fed term newborns. Pediatrics.1995;96:730\u2013733","DOI":"10.1542\/peds.96.4.730"},{"key":"2021121006194234800_R21","doi-asserted-by":"crossref","unstructured":"Penn AA, Enzman DR, Hahn JS, Stevenson DK. Kernicterus in a full term infant. Pediatrics.1994;93:1003\u20131006","DOI":"10.1542\/peds.93.6.1003"},{"key":"2021121006194234800_R22","doi-asserted-by":"crossref","unstructured":"Whyte J, Graham H. Prediction of the severity of ABO hemolytic disease of the newborn by cord blood tests. Acta Paediatr Scand.1981;70:217\u2013222","DOI":"10.1111\/j.1651-2227.1981.tb05545.x"},{"key":"2021121006194234800_R23","doi-asserted-by":"crossref","unstructured":"Levine DH, Meyer HB. Newborn screening for ABO hemolytic disease. Clin Pediatr.1985;24:391\u2013394","DOI":"10.1177\/000992288502400707"},{"key":"2021121006194234800_R24","doi-asserted-by":"crossref","unstructured":"McDonnell M, Hannam S, Devane SP. Hydrops fetalis due to ABO incompatibility. Arch Dis Child Fetal Neonatal Ed.1998;78:F220\u2013F221","DOI":"10.1136\/fn.78.3.F220"},{"key":"2021121006194234800_R25","doi-asserted-by":"crossref","unstructured":"Ozolek JA, Watchko JF, Mimouni F. Prevalence and lack of clinical significance of blood group incompatibility in mothers with blood type A or B. J Pediatr.1994;125:87\u201391","DOI":"10.1016\/S0022-3476(94)70131-8"},{"key":"2021121006194234800_R26","doi-asserted-by":"crossref","unstructured":"Maisels MJ. Neonatal hyperbilirubinemia. In: Klaus MH, Fanaroff AA, eds. Care of the High-Risk Neonate. Philadelphia, PA: WB Saunders;2001:331\u2013332","DOI":"10.1016\/B978-0-7216-7729-3.50017-2"},{"key":"2021121006194234800_R27","unstructured":"Katz MA, Kanto WP Jr, Korotkin JH. Recurrence rate of ABO hemolytic disease of the newborn. Obstet Gynecol.1982;59:611\u2013614"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/109\/4\/e53\/1114410\/pe0402000e53.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/109\/4\/e53\/1114410\/pe0402000e53.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,29]],"date-time":"2023-04-29T01:38:30Z","timestamp":1682732310000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/109\/4\/e53\/64067\/An-Early-Sixth-Hour-Serum-Bilirubin-Measurement-Is"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2002,4,1]]},"references-count":27,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2002,4,1]]},"published-print":{"date-parts":[[2002,4,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.109.4.e53","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2002,4,1]]}}}