Aim of the study:To compare cord blood albumin (CBA) and cord blood bilirubin (CBB) at birth as predictors for development of neonatal hyperbilirubinaemia. Material and methods: CBA and CBB of 388 healthy term neonates born by lower segment caesarean section (LSCS) were determined at birth and transcutaneous bilirubin (TCB) was measured every 12 hours from birth until 7 days of life or development of hyperbilirubinaemia requiring phototherapy. Results: The cut-off value of CBB and CBA as obtained by the receiver operating characteristic (ROC) curve was 1.90 mg/dl and 3.17 g/dl respectively. The sensitivity, specificity and positive predictive value (PPV) for CBB were 97.4%, 40.6% and 71.09% while for CBA they were 40.8%, 34.8% and 48.41%. The cut-off value for CBB/CBA ratio was 0.719 as obtained by the ROC curve and was determined to have 97.4% sensitivity, 62.6% specificity and a PPV of 79.61%. Conclusions: CBB/CBA is a better indicator compared to CBA and CBB alone for prediction of neonatal hyperbilirubinaemia.

We did not obtain institutional ethical/Institutional Review Board (IRB) approval for our submission due to the nature of our case study being a unique demonstration of medical knowledge without generalizability. J.D. designed the study, reviewed the medical record, wrote the main article, and performed a literature review. F.P. and N.C. revised the article and performed a literature review. N.C re-formatted the article and J.D. submitted the final version of the article. J.T., S.S., T.P., and K.P. critically reviewed the article and were instrumental in the evaluation and management of the patient. J.D. and F.P. performed the mitral valve replacement.

Abstract. Bartter Syndrome is a rare genetic disorder affecting the renal tubular system causing a decreased absorption of sodium and chloride in the thick ascending limb of the Henle loop. Most children present in infancy with complaints of polyuria, polydipsia, vomiting, constipation and failure to thrive while older children present with recurrent episodes of dehydration, muscle weakness and cramps. The present study aimed to demonstrate a case of Bartter syndrome presenting as acute gastroenteritis.