Objective <p>We aim to describe sequential direct bilirubin levels in preterm infants and examine the outcomes of subsequent evaluation of direct hyperbilirubinemia.</p> Study design <p>Retrospective electronic chart analysis of preterm infants admitted and surviving the neonatal intensive care unit (NICU) stay was performed.</p> Result <p>A total of 127 preterm infants had 665 bilirubin measurements (333 direct bilirubin; 332 total bilirubin) during their first NICU stay. Before five days of age, twenty-seven (27/127, 21%) infants had abnormal direct bilirubin estimations. At fourteen days, three of these infants (3/27, 11%) had abnormal values. All three infants had further testing and more direct bilirubin estimations than their cohort. All infants had normal levels by discharge. Age-appropriate direct bilirubin values were based on those described by Feldman et al.</p> Conclusion <p>All preterm infants with elevated direct bilirubin had normal values by discharge.</p>