Study of Correlation of Cord Blood Bilirubin with Neonatal Hyperbilirubinemia

Abstract

Introduction: Neonatal Hyperbilirubinemia (NH) is a universal problem affecting nearly 60% of term and 80% of preterm neonates during first week of life. Early discharge of healthy term newborns is a common practice because of medical, social and economic constraints. Insignificant number (6.5%) of babies, NH is a cause for readmission. The present study was conducted to correlate the Cord Blood Bilirubin (CBB) level with subsequent NH. Methods: Study was performed at the Department of Pediatrics in a Medical College Hospital and Research Centre. Intramurally delivered, 113 Healthy fullterm newborns during 1-year period were prospectively enrolled. CBB was estimated. Serum Bilirubin estimation was done at 48 hours and 5 day of age and later if required. Results: Significant NH in our study is 3.5%. Mean total bilirubin on second postnatal day was 10.58 mg/dl and on fifth post natal day was 10.81 mg/dl. Using CBB level of ≥3 mg/dl as a cut-off, NH can be predicted with sensitivity of 100%, specificity of 98.17 %, positive predictive value of 66.67 % and negative predictive value of 100%. Conclusion: A 100% Negative Predictive Value in the present study suggests that in Healthy Term babies (without RH and ABO incompatibility with Cord Blood Bilirubin ≤3mg/dl) cord serum bilirubin can help to identify those newborns who are unlikely to require further evaluation and intervention. These newborns can be discharged with assurance to Parents. Babies with CBB level ≥3mg/dl should be followed more frequently.

Early predictors of neonatal hyperbilirubinemia in full term newborn

“…Severe hyperbilirubinemia can occur without apparent reason in healthy infants, and some may develop kernicterus. 1 The prevention of poor outcomes necessitates early detection of neonates who are at risk of developing significant hyperbilirubinemia.…”

Umbilical Cord Bilirubin Level as a Predictor of Subsequent Neonatal Hyperbilirubinaemia in Term Healthy Newborns

“…10 In another Indian study by Ahire N et al reported sensitivity of 100%, specificity of 98.17% and positive predictive value of 66.67%, negative predictive value of 100% using cord bilirubin cut-off ≥3 mg/dL. 11 Thus, it can be seen that different authors have used different cut-off value for predicting significant jaundice. Bilirubin estimation varies from laboratory to laboratory, depends on methods used, technical error, ethnic makeup of people, etc.…”

Prospective study on cord bilirubin level as a predictor of Hyperbilirubinemia in term healthy neonates

“…The cutoff value for prediction of hyperbilirubinemia is different in different studies. Prospective study conducted by Ahire reported that neonates with cord blood bilirubin ≥ 3mg/dl should be monitored more frequently [10]. The cut-off point for cord blood bilirubin in full-term neonates was given as 2.15 mg/dl in another prospective clinical study [8].…”