Background: Respiratory disease in the very preterm infant is frequent and often severe. Bilirubin is both a potent neurotoxin and antioxidant, and may have a clinical impact on preterm respiratory disease. The Gilbert genotype, the UGT1A1*28 allele, is the major known genetic cause of variation in bilirubin. Objectives: To study the association between respiratory disease in the very preterm infant and the UGT1A1*28 allele. Methods: This is a cohort study of 1,354 very preterm infants (gestational age