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Neonatal Bilirubin Total and Direct

Baby Bilirubin, Bilirubin, Neonatal (includes Total and Direct)

Test Codes

EPIC: LAB5019, Beaker: BILNE, Antrim: 13590

Department

Chemistry

Instructions

This test must only be ordered on infant patients less than 120 days old. 

Specimen Collection Criteria

FOR EC AND INPATIENT SAMPLE COLLECTION ONLY:

Preferred Sample:  One Light Green (Mint) Top Plasma Separator Tube (PST) or Microtainer® (minimum Whole Blood: 1.0 mL)

Acceptable Sample:  One Gold-top SST tube or Microtainer®. (Minimum Whole Blood: 1.0 mL) 

FOR PHYSICIAN OFFICE/OUTREACH SAMPLE COLLECTION:

Collect: One Gold-top SST tube or Microtainer®. (Minimum Whole Blood: 1.0 mL) 

See Minimum Pediatric Specimen Requirements for Microtainer^® collection.
Protect specimen from prolonged exposure to light. Send to the Laboratory immediately for processing. 

Physician Office/Draw Specimen Preparation

Protect specimen from light. Let SST specimens clot for 30–60 minutes then immediately centrifuge to separate serum from cells.  Refrigerate (2–8°C or 36–46°F) the centrifuged SST tube or Microtainer^® within two hours of collection.

Preparation for Courier Transport

Transport: Centrifuged SST tube or Microtainer®, refrigerated (2–8°C or 36–46°F).

Rejection Criteria

Moderate to grossly hemolyzed specimens.

Red-top tubes with serum not separated from cells within two hours of collection. 

Inpatient Specimen Preparation

Protect specimen from prolonged exposure to light. Transport specimen to the Laboratory immediately for processing.

In-Lab Processing

Let SST specimens clot 30–60 minutes. Centrifuge SST tubes or Microtainers^® to separate serum from cells. Deliver immediately to the appropriate testing station. 

Storage

Specimen Stability for Testing:

Centrifuged SST Tubes and Microtainers^® with Separator Gel
Room Temperature (20–26°C or 68–78.8°F): 2–4 hours
Refrigerated (2–8°C or 36–46°F): 7 days
Frozen (-20°C/-4°F or below): Unacceptable

Red-top Tubes and Microtainers^® without Separator Gel
Room Temperature (20–26°C or 68–78.8°F): 2–4 hours
Refrigerated (2–8°C or 36–46°F): Unacceptable
Frozen (-20°C/-4°F or below): Unacceptable

Serum Specimens (Pour-Overs)
Room Temperature (20–26°C or 68–78.8°F): 2–4 hours
Refrigerated (2–8°C or 36–46°F): 7 days
Frozen (-20°C/-4°F or below): 7 days

Specimen Storage in Department Prior to Disposal:

Refrigerated (2–8°C or 36–46°F): 7 days

Laboratory

Dearborn Chemistry Laboratory
Farmington Hills Chemistry Laboratory 
Grosse Pointe Chemistry Laboratory 
Livonia Main Laboratory
Lenox Main Laboratory
Royal Oak STAT Laboratory 
Troy Chemistry Laboratory
Taylor Chemistry Laboratory
Trenton Chemistry Laboratory
Wayne Chemistry Laboratory 

Performed

Sunday – Saturday, 24 hours a day.
STAT results available in less than 1 hour after receipt in the Laboratory.
Routine results available the same day. 

Reference Range

Neonatal Direct Bilirubin

Age (Days)	Reference Range (mg/dL)
0 – Less than 28	0.0 – 1.0
28 or greater	0.0 – 0.4

Neonatal Total Bilirubin

Age	Reference Range (mg/dL)
0 – 23 Hours	0.3 – 7.9
24 – 35 Hours	0.3 – 10.0
36 – 47 Hours	0.3 – 12.0
48 – 59 Hours	0.3 – 12.0
60 – 71 Hours	0.3 – 15.0
72 – 83 Hours	0.3 – 15.0
84 – 144 hours	0.3 – 15.0
145 hours – 13 days	0.3 – 15.0
14 –  20 Days	0.3 – 8.0
21 –  27 Days	0.3 –6.0
28 Days – ADULT	0.3 – 1.2

Test Methodology

Spectrophotometric.

Interpretation

Protect specimens from light because bilirubin is extremely photosensitive. Decreases in bilirubin levels can occur in as little as 1 hour if exposed to bright sunlight.

Clinical Utility

This assay is used to assess the degree of jaundice in a neonate. The most common cause of neonatal jaundice is physiologic jaundice. Other causes include hemolytic disease of the newborn, hypothyroidism, galactosemia, Crigler-Najar syndrome, Dubin-Johnson syndrome, and obstructive jaundice. Obstructive jaundice (e.g., biliary atresia) or Dubin-Johnson syndrome are associated with an increase in direct bilirubin. Direct bilirubin should not be increased in the other conditions listed.

CPT Codes

82247, 82248

Contacts

Last Updated

10/3/2023