Prediction of the Development of Neonatal Jaundice by Increased Umbilical Cord Blood Bilirubin

Abstract

Umbilical cord serum bilirubin concentration as a predictor of subsequent jaundice was studied in 291 newborns. It was possible to define subgroups of infants with significantly higher or lower risks of developing jaundice. If cord bilirubin was below 20 mumol/l, 2.9% became jaundiced as opposed to 85% if cord bilirubin was above 40 mumol/l. Furthermore, 57% of jaundiced infants with cord bilirubin above 40 mumol/l required phototherapy, but only 9% if cord bilirubin was 40 mumol/l or lower (p less than 0.003). Knowledge of infants at risk of developing jaundice allows simple bilirubin reducing methods to be implemented before jaundice is present and could influence a decision regarding early discharge from hospital. Since the ability of plasma to bind bilirubin in cord blood from jaundiced and non-jaundiced infants showed no significant differences, the increased cord bilirubin among infants who later became jaundiced is presumably caused by increased fetal bilirubin production or decreased removal of bilirubin from the fetal circulation.

Prediction of significant hyperbilirubinemia using 24 hour serum bilirubin

“…18 In contrast studies by Taksande A et al, Rostami et al, Knudsen A, found no association between mode of delivery and significant hyperbilirubinemia. 15,[19][20] This does not match with the inference of this study.…”

Bilirubin dosage in cord blood: could it predict neonatal hyperbilirubinemia?

“…In addition, the latter group also presented a higher chance of needing to undergo phototherapy. Knudsen,24 in 1989, carried out a study to demonstrate that jaundiced newborns presented higher umbilical cord blood bilirubin levels than newborns without clinical jaundice. In addition, the number of jaundiced newborns undergoing phototherapy was significantly higher when these levels were higher than 2.3 mg/100 ml, in comparison with the number of jaundiced newborns with no need for treatment and whose bilirubin levels were lower than or equal to 2.3 mg/100 ml.…”

Routine transcutaneous bilirubin measurements combined with clinical risk factors improve the prediction of subsequent hyperbilirubinemia

“…We therefore assumed a cord TcB level of 1.7 mg per 100 ml based on published values of mean bilirubin levels in the cord blood. [12][13][14] When this was done, gestational age groups, feeding method, the calculated rate of rise and birth weight all entered the model and provided a c-statistic for the ROC curve of 0.903 (not significantly different from our original model P ¼ 0.316). When the last measured TcB was substituted for the peak TcB, the same variables entered the model (gestational age, feeding and percentile groups) with a c-statistic for the ROC curve of 0.873, not significantly different from either of the earlier calculated ROC curves (P ¼ 0.292).…”