Canadian Medical Association Journal. 2004;114:297. Your baby's provider will want to check the level again in 2 to 3 . The liver normally absorbs and processes bilirubin, but in the newborn there are not enough enzymes present yet for the liver to absorb and metabolize the bilirubin. If a finger lightly pressed on a baby's skin causes that area of skin to become yellow, it's likely a sign of jaundice. Kernicterus may result in: The best preventive of infant jaundice is adequate feeding. National Institute of Diabetes and Digestive and Kidney Diseases. May 23, 2018 10.49am EDT. About 60% of full-term newborns and 80% of premature babies get jaundice. Many hospitals check total bilirubin levels on all babies at about 24 hours after birth, often using a probe that can estimate the levels simply by touching the skin., The point at which a bilirubin level is dangerous changes with a baby's age. This is called kernicterus. https://www.uptodate.com/contents/search. your baby dehydrated. This condition can’t really be prevented except in the case of breastfeeding failure jaundice. If the lab finds evidence that your baby has an abnormal breakdown of red blood cells, healthcare providers may repeat this test as often as every 14 days. Hyperbilirubinemia happens when This evidence-based publication features expected outcomes for mothers and babies along with 21 specific management strategies to guide clinicians in caring for breastfeeding families. Patients. Feb. 5, 2020. Bilirubin levels typically peak between 3 to 7 days after birth. The harmful may be occurred to the baby by bilirubin differs by the bilirubin level in the blood over the next days of birth until 4 to 8 weeks Bilirubin level in the day 1 of birth until day four start down from 6 - 8 mg/dl and peaks within next three days and may be peaked or over peaked to 13 - 18 mg/dl in the day four of birth, it . There is Often physiological jaundice in newborns. Easily visualize complex aspects with a full-color layout and images, as well as numerous tables throughout the text. What Health Problems Do Micro Preemies Have? Track your baby’s most exciting moments with our milestone checklist. However, for some babies jaundice becomes severe, a condition known as hyperbilirubinemia. Bilirubin is the pigment that turns the skin yellow. To describe the incidence, etiology, treatment, and outcome of newborns with total serum bilirubin (TSB) levels ≥30 mg/dL (513 μmol/L). A rise to 12mg/dL is in the physiologic range. Your baby may have too much bilirubin for many reasons. 5 Reasons You May Want to Avoid Inducing Labor (Even if You're Overdue), How Gestational Diabetes Affects Mothers, Babies, and the Birth Process, What to Know About Babies and Cephalohematomas, Intrahepatic Cholestasis of Pregnancy (ICP) Symptoms and Treatment, RhoGAM Is Given to Certain Rh Negative Women After Delivery, How Your Rh Factor Can Affect Your Pregnancy. Bilirubin level ; You must keep the light therapy on your child's skin and feed your child every 2 to 3 hours (10 to 12 times a day). Wong RJ, et al. This late-onset jaundice may develop in up to one third of . Results are based on the Hour-Specific Nomogram for Risk Stratification published in "Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation" (2004) by . Muchowski KE. Read our, Jennifer Polixenni Brankin/Contributor/Getty Images, What You Should Know If Your Preemie Has Jaundice, Premature Babies Can Face Many Health Issues Depending on Age. © 2021 Cedars-Sinai. This makes bilirubin Call your doctor if: Excess bilirubin (hyperbilirubinemia) is the main cause of jaundice. Found inside – Page 35Seizure continues Table 2.18: Rough Guide to Serum Bilirubin Levels with Respect to Dermal Staining Face 4–6 mg/dl ... Baby remains otherwise healthy • Jaundice clears spontaneously within 7–10 days of life • Jaundice starts on day 1 ... But it may be hard at first to tell if jaundice is being caused by another problem. It may help his or her healthcare provider make a diagnosis. Formula-fed infants usually should have 1 to 2 ounces (about 30 to 60 milliliters) of formula every two to three hours for the first week. High levels of bilirubin can travel to your baby’s brain. The goal is to keep the level of bilirubin from increasing to dangerous levels while minimizing any negative effects of the treatment. In fact, parents are typically instructed to keep an eye out for signs of severe jaundice after taking their newborn home from the hospital, including:, When bilirubin levels become high enough to bring on these symptoms, a baby is at risk of developing kernicterus., There are a variety of reasons a baby might develop severe jaundice. The baby is placed underneath special blue lights—bili lights—in a warm, enclosed bed wearing only a diaper and special eye shades. In newborns, the body may produce more bilirubin than the liver can process. A baby with jaundice needs to take in plenty of fluids with breast milk or formula: Feed the baby often (up to 12 times a day . There is Often physiological jaundice in newborns. Evaluation and treatment of neonatal hyperbilirubinemia. Updated November 26, 2019. When your baby is discharged from the hospital, your doctor or nurse will look for jaundice. It is not dangerous but tests may need to be done for other problems that are dangerous. They can include: The symptoms of this health problem may be similar to symptoms of other conditions. So do 80% of premature babies. Jaundice may be hard to see, especially in babies with dark skin. A baby with jaundice has skin that looks yellow. The color sometimes begins on the face and then travels downward, to the chest, belly, legs, and soles of the feet.. If the bilirubin level is elevating towards the upper percentile curves, hemolysis is considered and the baby is monitored and investigated accordingly (9, 16) Found inside – Page 236In most cases, the baby's systems continue to develop and can soon process bilirubin. ... than 0.5 mg/dl per hour or 5 mg/dl per day, if total bilirubin levels exceed 15 mg/dl in a full-term infant or 10 mg/dl in a preterm infant, ... Bilirubin is carried through the blood . The following signs or symptoms may indicate severe jaundice or complications from excess bilirubin. Bilirubin levels which are above treatment levels at 4 days may not require phototherapy at 14 days. The phototherapy charts are not validated in infants of this age. Revised and updated by a new editorial team, the Sixth Edition of this text will remain the leading reference on the clinical care of the newborn. Accessed Jan. 13, 2020. Wong RJ. The liver is the part of the body most responsible for getting rid of bilirubin. Signs of acute bilirubin encephalopathy in a baby with jaundice include: Kernicterus is the syndrome that occurs if acute bilirubin encephalopathy causes permanent damage to the brain. Mayo Clinic is a not-for-profit organization. If the jaundice is not treated, high levels of bilirubin can lead to brain damage . Here is a bit more about when newborns with jaundice may need some treatment. It will first appear on your baby's face and chest. Found inside – Page 257De Bruijne: Well, I can tell you that most of our praemature babies got breast milk during the first few days of life. ... Because if you don't determine bilirubin four or five times, the day that the bilirubin level is rising, ... This type of bilirubin is called unconjugated, or indirect, bilirubin. 15 mg or higher. The bilirubin levels will eventually decrease. A small amount of bilirubin in your blood is normal. Less than 24 hours old. Bilirubin levels typically peak between 3 to 7 days after birth. This three-volume textbook emphasizes the application as well as the theory of medical genetics across the full spectrum of inherited disorders. A stand-alone volume or as a companion to AAP Textbook of Pediatric Care, a comprehensive and innovative pediatric textbook based on Hoekelman's Primary Pediatric Care, this all-new book focuses on the core components of pediatric care ... Too much may be a sign of liver disease. A baby with a very high bilirubin level might need a blood transfusion in the hospital. This will tell if phototherapy is working. Over 9000 English-language entries to medical terminology, with etymology given in Japanese and English. Entries include word in English; part of speech; Greek, Latin, or other roots; and elements of word. The timing of when your child's jaundice first starts matters. This can stop your baby’s bilirubin levels from rising to dangerous levels. During the first few days of life, babies aren’t able to get rid of much bilirubin. If a baby's bilirubin level is high, then blood tests are performed., Severe jaundice is treated with phototherapy. The baby is likely to feed poorly. Choose a doctor and schedule an appointment. It occurs in 5% to 10% of . Diseases or conditions that can cause jaundice include: Major risk factors for jaundice, particularly severe jaundice that can cause complications, include: High levels of bilirubin that cause severe jaundice can result in serious complications if not treated. During light treatment, your baby’s eye will be protected. Jaundice in newborns could be an evolutionary safeguard against death from sepsis. Verywell Family uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. If you are breastfeeding, you should nurse the baby at least 8 to 12 times a day for the first few days. well at first. The most common include:. Direct bilirubin 0, 0.1, 0.2, and 0.3 is normal results and cannot be a cause of jaundice unless indirect bilirubin continue to be high. The level of bilirubin peaks 3- 7 days after birth. Jaundice may first appear when your baby is born. Found inside – Page 915.79 A healthy, thriving 10-day-old baby is diagnosed with a bilirubin level of 120 mg/dL (17 mmol/L). The FIRST suggestion for his care should be to: a. replace most of the breastfeeds with artificial baby milk. b. institute ... Pediatrics. It will also depend on how severe the condition is. The term Jaundice comes from the French word jaundice, which means yellow; thus a jaundiced baby is one whose skin color appears yellow due to bilirubin. Jaundice in breast fed babies usually appears between 24-72 h of age, peaks by 5-15 days of life and disappears by the third week of life. Healthy adults make 250 to 350 milligrams (mg) of bilirubin each day. Infant jaundice is a common condition, particularly in babies born before 38 weeks' gestation (preterm babies) and some breast-fed babies. This raises your baby’s red blood cell count. This all-new from the American Academy of Pediatrics Council on Foster Care, Adoption, and Kinship Care brings contributions from leading child health and welfare professionals nationwide. Physiologic (Nonpathologic) Hyperbilirubinemia. This can stop your child’s bilirubin from rising to dangerous levels. A fiber optic blanket is another form of phototherapy. Ullah S, Rahman K, Hedayati M. Hyperbilirubinemia in neonates: Types, causes, clinical examinations, preventive measures and treatments: A narrative review article. A problem with the liver can cause higher levels of bilirubin. It makes a baby’s skin, eyes, and other tissues turn yellow (jaundice). The newborn infant. build up in your baby’s body. Objective. Unlike other books on the market, this series helps students learn in the context of real patients instead of simply memorizing. Whether the baby was born early (babies born early are more likely to be treated at lower bilirubin levels) How old the baby is ; A baby will need treatment if the bilirubin level is too high or is rising too quickly. Subsequent measurements can be total bilirubin alone. https://www.niddk.nih.gov/health-information/liver-disease/biliary-atresia/all-content. Or, can enter a comma-separated list of ages and bilirubin levels, to assess trends on the plot. But this condition is also common in early-term Newborn NH screening can happen during the first days of life at the bedside or in the nursery. Peaks: 15.0 at 5 to 7 days; Resolves at 10 to 14 days of life; Exagerated Physiologic Jaundice. Once the baby is improving; read bilirubin levels are stable or decreasing, I can be more liberal with time allowed without light therapy. As long as hyperbilirubinemia is diagnosed and treated right away, potentially devastating complications can be avoided. In newborn babies, jaundice is so common as to be termed . Not feeding well makes © 1998-2021 Mayo Foundation for Medical Education and Research (MFMER). The whites of a baby's eyes also look yellow. High levels of bilirubin can lead to jaundice, which is characterized by yellowing of the skin and eyes. Mild jaundice is a common condition in newborns because all babies go through a period of rapid red blood cell breakdown after birth. What to Know About Cutting the Umbilical Cord After Birth, Hyperbilirubinemia in neonates: Types, causes, clinical examinations, preventive measures and treatments: A narrative review article, Jaundice and kernicterus guidelines and tools for health professionals, Hemolytic disease of the fetus and newborn: Current trends and perspectives, Estimation of bilirubin using BiliChek, a transcutaneous bilirubin measurement device: Effects of gestational age and use of phototherapy, Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation, dark urine or not enough wet or dirty diapers, Jaundice appeared within the first 24 hours of life, Erythroblastosis fetalis (a blood disorder), Hemolytic anemia (a red blood cell disorder). When to . If a baby's bilirubin level is high, then blood tests are performed. Critical Values for Infants (<12 Months) Laboratory values in the critical range will be reported by telephone immediately. If a baby has severe jaundice, there's a risk of bilirubin passing into the brain, a condition called acute bilirubin encephalopathy. It may be used alone or with regular phototherapy. In this procedure, the baby's blood is replaced with fresh blood. Bilirubin is toxic to cells of the brain. Numerous previous studies have analyzed the bilirubin rebound after phototherapy, 10, - 15 but none have approached the sample size studied by Chang et al. In this volume the latest research on vitamin D and rickets is presented from different perspectives such as the interesting historical overview to bone metabolism, molecular genetics of vitamin D and conclusions for disease prevention. The book includes a wide range of examples of positive change - plus key practical points highlighted throughout the text - to help readers achieve improvements in patient care. Because the baby has an immature liver, bilirubin is processed slower. The new edition of this popular text features practical advice on the safe, effective administration of general and regional anesthesia to infants and children. View answer 10 mg or higher. bilirubin (TSB) level usually rises in full-term infants to a peak of 6 to 8 mg/dL by 3 days of age and then falls. Bilirubin, which is responsible for the yellow color of jaundice, is a normal part of the pigment released from the breakdown of "used" red blood cells. The most common symptom is yellowing of your baby’s skin and the whites of his or her eyes. It also lowers his or her bilirubin level. USA/Australia/UK normal bilirubin levels USA: Serum bilirubin levels, by age of baby (hours old): bilirubin measurement (micromole/litre) Less than 24 hrs: above 180. Bilirubin levels in the blood tend to peak when your baby is between three and seven days old. Jaundice can happen if your baby’s liver doesn’t work well. The skin on your baby's the abdomen, arms or legs looks yellow, The whites of your baby's eyes look yellow, Your baby seems listless or sick or is difficult to awaken, Your baby isn't gaining weight or is feeding poorly, Your baby develops any other signs or symptoms that concern you, An infection in your baby's blood (sepsis), An incompatibility between the mother's blood and the baby's blood, Biliary atresia, a condition in which the baby’s bile ducts are blocked or scarred, An abnormality of your baby's red blood cells that causes them to break down rapidly, Involuntary and uncontrolled movements (athetoid cerebral palsy). Print+CourseSmart strength to breastfeed well. Most babies who present with true breast milk jaundice (only 0.5% to 2.4% of all newborns) may see another rise in bilirubin levels at about 14 days. Your baby should be examined for jaundice between the third and seventh day after birth, when bilirubin levels usually peak. Also Read: Yellow Eyes? • If breastfeeding is continued, bilirubin gradually decreases but may persist for 3-10 wk at lower levels. Some bilirubin is bound to a certain protein (albumin) in the blood. Levels of Bilirubin. Sometimes, when the baby needs only single phototherapy such as bili-blanket, the mother can hold her baby and feed it without discontinuing the treatment. This visual check does not measure exact bilirubin levels and can be . Your baby’s healthcare provider will check your baby’s temperature. Based on. I n the term infant, physiologic hyperbilirubinemia appears at about two days of age, peaks at 10 to 12 mg/dl at three to four days and disappears by four to seven days. If your baby is discharged earlier than 72 hours after birth, make a follow-up appointment to look for jaundice within two days of discharge. This test is used to find out how well your liver is working. Found inside – Page 171MANAGEMENT OF HYPERBILIRUBINEMIA IN THE TERM NEWBORN Serum bilirubin level ( mg / dL ) Age ( hrs ) Exchange ... first 3-4 days of life , an infant's serum bilirubin increases to 6.5 2.5 mg / dL , then decreases to normal by 10–14 days . Listed in this appendix are pediatric normal ranges for some of the more common hematology and chemistry tests along with the references from which they were obtained. Found inside – Page 11The problem is often resolved in seven to 10 days after the baby's liver becomes more efficient . In contrast to the low and harmless levels of bilirubin caused by an immature liver , very high levels of bilirubin can be harmful and may ... Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Examine your baby in good lighting conditions, preferably in natural daylight. Advertising revenue supports our not-for-profit mission. The baby's . 2009;124:1193. Bilirubin conversion from US to SI units is 17.1. there is too much bilirubin in your baby’s blood. Rarely, an unusually high blood level of bilirubin can place a newborn at risk of brain damage, particularly in the presence of certain risk factors for severe jaundice. A bilirubin level more than 34 μmol/l (2 mg/dL) may be visible. What are jaundice and kernicterus?. A 501(c)(3) non-profit organization. The yellowish appearance is a sign of an increased blood pigment called Bilirubin, which then settles in the skin. To screen for NH, doctors and nurses can check newborns for yellow skin or eyes. *Note: The default unit of measure for total bilirubin is mg/dl.Please select µmol/L if your bilirubin values are captured in the global standard SI metric units. 2011;5(1):3–7. During phototherapy, the baby is placed under ultraviolet light. This is caused by elevated bilirubin levels in the newborn's blood. Clinical manifestations of unconjugated hyperbilirubinemia in term and late preterm infants. Ⓒ 2021 About, Inc. (Dotdash) — All rights reserved. Use total bilirubin. So it's important for your doctor to examine your baby for jaundice during that time. It usually takes only a day or two of phototherapy in the hospital to bring bilirubin levels down to normal.. This happens later in their first week of life. healthcare team will check the baby's bilirubin level. In many cases this is a normal process and occurs in about 2/3 of all healthy newborns. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. An elevated bilirubin level adversely affects the central nervous system. It usually gets better once a baby learns how to breastfeed well. Found insideJaundice becomes clinically apparent, usually on the second or third day of life, if the bilirubin level rises above 85 μmol/L. The child usually remains well and the jaundice settles over the course of 7–10 days. During the birth of a baby threshold detention substances can reach 51 µmol/L. It can help his or her healthcare provider make a diagnosis. Centers for Disease Control and Prevention. In case of breastfed newborns, mild jaundice may take 10-14 days after birth or may reoccur during the breast feeding period . more likely to get this problem. [I-C*] Choose appropriate test for bilirubin levels (Table 4). Eleven Northern California Kaiser Permanente Medical Care Program hospitals and 1 affiliated hospital. * If direct bilirubin is <1.5 mg/dL, may use total bilirubin † Anticipates peaking of serum bilirubin at 72 hours **consider institution of phototherapy In infants found to be clinically jaundiced during the first 2-3 days, it is helpful to document the rate of rise in the serum bilirubin level. Pediatrics. A total bilirubin (TSB or TcB) level should be measured on all newborns prior to discharge. If approaching treatment levels, recheck the bilirubin within 1-2 days to ensure that it is decreasing. Bilirubin is made by the breakdown of red blood cells. This treatment removes your baby's blood that has a high bilirubin level. If a finger lightly pressed on a baby's skin causes that area of skin to become yellow, it's likely a sign of jaundice. There is breastfeeding jaundice. Edited by three of the field’s most respected neonatal care experts, the book uniquely explains how the imbalance between bilirubin production and elimination leads to jaundice—and that hazardous levels of unconjugated bilirubin can ... Jaundice, a sign of elevated bilirubin levels, is common during the first weeks of life, especially among preterm newborns. This substance may increase how much bilirubin the baby's body can reabsorb. Risk factors = isoimmune hemolytic disease, G6PD deficiency, asphyxia, significant lethargy, temperature instability, sepsis, acidosis, or albumin <3g/dL. Maisels MJ, et al. In premature infants, the peak may be 10 to 12 mg/dL on the fifth day of life, possibly rising over 15 mg/dL without any specific abnormality of bilirubin metabolism. It replaces it with fresh blood that has a normal bilirubin level. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. Treatment for newborn jaundice is not usually needed because the symptoms normally pass within 10 to 14 days, although they can occasionally last longer. Jaundice (yellow skin) in a baby during the first 3 months of life (90 days) The skin turns a yellow color from high bilirubin levels in the blood; Jaundice and Bilirubin. Subcommittee on Hyperbilirubinemia. Breast-feeding jaundice: Breast-feeding jaundice may occur when your baby does not drink enough breast milk. On inpatients, the laboratory will attempt to phone the physician first; however, if the physician listed as the ordering physician is incorrect or does not respond within 10 minutes, the patient's nurse will be notified. Protection from sunlight for 10 days . To use sunlight to treat newborn jaundice, put your baby in a well-lighted window for 10 minutes twice a day. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. [2010] 1.4.10 If the serum bilirubin level falls during intensified phototherapy to a level 50 micromol/litre below the threshold for which exchange transfusion is . Normally, the liver filters bilirubin from the bloodstream and releases it into the intestinal tract. You may notice it between 1 and 4 days after your baby is born. his bilirubin total level is 21.5 and the bilirubin indirect total is 2.0. hemoglobin is 8.6 hematocrit is 24.9 wbc 8.8 neutrophils 25.1 lymphocytes 64.4 monocytes 10.5. 23rd ed. Jaundice is a condition that can occur in newborns, within 2-3 days of birth. Mayo Clinic facts about coronavirus disease 2019 (COVID-19), Our COVID-19 patient and visitor guidelines, plus trusted health information, Mayo Clinic Health System patient vaccination updates, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, Book: Mayo Clinic Family Health Book, 5th Edition, Newsletter: Mayo Clinic Health Letter — Digital Edition, Try Mayo Clinic Health Letter - get FREE book. This site complies with the HONcode standard for trustworthy health information: verify here. I took him in for follow up blood work the day after we were released, and they readmitted us for continued light therapy because he had . Your baby may need to have this procedure again if his or her bilirubin levels stay high. Lyndsey Garbi, MD, is a pediatrician who is double board-certified in pediatrics and neonatology. doi:10.4103/0973-6247.75963, Jangaard K, Curtis H, Goldbloom R. Estimation of bilirubin using BiliChek, a transcutaneous bilirubin measurement device: Effects of gestational age and use of phototherapy. About 60% of full-term newborns get jaundice. Found inside – Page 100It fades within 10 days . Babies remain well , gain weight and pass yellow stools . Immediate steps # Check the mother's blood group . Start phototherapy ( p . 107 ) . Check the level of serum bilirubin four - hourly . http://pediatrics.aappublications.org/content/114/1/297. Day 2 255 (15) 170 (10) 425 (25) 255 (15) . Updated December 2018. Management if baby is well and investigations are normal. Most infants born between 35 weeks' gestation and full term need no treatment for jaundice. This is one volume of a two-volume work on neurocognitive development, focusing separately on normative and non-normative development. This compilation will feature more than 300 focused entries, including sections on different disease states, pathophysiology, epidemiology, genetics, clinical presentation, diagnostic tools, as well as discussions on relevant basic science ... For all babies, spotting jaundice early and getting treatment right away are key. The American Academy of Pediatrics recommends that newborns be examined for jaundice during routine medical checks and at least every eight to 12 hours while in the hospital. Feeding prevents dehydration and helps bilirubin leave the body. Testing for bilirubin may be done after 25 weeks of pregnancy. If your baby's bilirubin level continues to rise, your baby might need an exchange . BabyCues is a revolutionary parenting book. Iran J Public Health. Critical Values for Infants (<12 Months) Laboratory values in the critical range will be reported by telephone immediately. It starts on the face, then the chest and stomach, and then the legs. He or she will also test your baby’s bilirubin levels. This will be done through a vein or artery in the baby's umbilical cord. This 2-volume "bible" of neonatology has been exhaustively updated to reflect all of the sweeping developments that have recently occurred in neonatal-perinatal medicine. It replaces it with fresh blood that has a normal bilirubin level. Subsequently, it gradually increases, and at 3-4 days of life, reaches a maximum. Prolonged and very high bilirubin levels can lead to complications if left untreated, so testing is commonly performed in newborns during their first few days of life and when signs of jaundice appear. In rare cases, a baby may receive extra fluids intravenously. An elevation greater than 20 mg/dL suggests severe liver disease. Yellowing of your baby’s skin and the whites of his or her eyes. Most well newborns with jaundice have physiological jaundice with unconjugated bilirubin and usually do not require specific treatment. This guideline applies to neonates within the first two weeks of life. Found insideBabies become jaundiced when the level of bilirubin in the plasma exceeds the albumin binding sites or the ability of ... bilirubin where there is delayed conjugation and excretion, the jaundice will usually disappear with 7–10 days. newborns (37 to 38 weeks). Updated November 26, 2019. When your baby is discharged from the hospital, your doctor or nurse will look for jaundice. These babies often don’t have the coordination and So breast feeding jaundice occurs when your baby does not get enough breast milk, and it occurs in about 5% to 10% of newborns. Prompt treatment may prevent significant lasting damage. From born at term children bilirubin level should not be above 256 µmol/l, preterm - 171.
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