Umbilical cord albumin and serum bilirubin as predictive factors for hyperbilirubinemia in term neonates

Abstract

Background: Hyperbilirubinemia is one of the common causes of neonatal admission. As clinical evaluation may cause a delay in identification and subsequent initiation of medical therapy, there is a need for the sensitive and inexpensive predictive marker for hyperbilirubinemia in neonates. Measurement of cord albumin and its correlation with the serum bilirubin is one of the noninvasive predictive markers for Hyperbilirubinemia. The present study carried out to know the significance of umbilical cord albumin level as a predictor of neonatal hyperbilirubinemia.Methods: It is a hospital-based prospective cohort study, total 100 healthy term new-borns admitted in the Neonatal Intensive Care Unit, were included in the study as per study protocol over a period of one year. The blood sample was collected from umbilical cord blood for the analysis of bilirubin and albumin, and post 72 hours of life venous blood obtained for estimation of serum bilirubin and albumin along with direct and indirect Coombs test.Results: In this study most of the patients were in the gestational age of 37-38 weeks (71%) followed by 38-40 weeks (27%) and only 1% are >40 weeks. A positive correlation was observed between cord blood bilirubin, serum bilirubin, serum albumin, and cord blood albumin levels. Cord blood albumin was a better marker for neonatal hyperbilirubinemia with a sensitivity of 83%, and a specificity of 48%; as compared to cord blood bilirubin with a sensitivity and specificity of 73% and 39% respectively.Conclusions: From this study, cord blood albumin level was demonstrated as a good predictive marker for neonatal hyperbilirubinemia with a sensitivity of 83.1%. and specificity 48.8%. Hence, cord blood albumin may be used as a non-invasive predictor for neonatal hyperbilirubinemia.

Prediction of Neonatal Hyperbilirubinemia from Cord Blood Bilirubin and Cord Blood Albumin Ratio in Healthy Term Indian Neonates

“…We chose to employ those combined as the CBB to CBA ratio so as to achieve a greater sensitivity, specificity, NPV, and PPV than either CBB or CBA individually. Cut-off points of the CBB/CBA ratio attained in other studies 27–30 for the prediction of the development of significant hyperbilirubinemia were 0.60, 0.78, and 0.98. ROC curve estimation on the CBB/CBA ratio showed a cut-off point of 0.630 with a sensitivity of 91.66%, specificity of 86.84%, PPV of 68.75%, and NPV of 97.05%.…”

“…In countries with limited resources and high patient-to-bed ratios, early identification of hyperbilirubinemia aids with prompt discharge, prevent re-hospitalization, and decrease the amount of time of newborns' and mothers' hospital stay. [12][13][14][15] Therefore, a marker that can accurately anticipate the onset of severe jaundice in a newborn is always needed. In our study, we observed that 24% of newborns had neonatal hyperbilirubinemia, which is close to Bernaldo et al 16 that reported a somewhat comparable frequency of 19.86%.…”

Ratio of cord blood bilirubin and albumin as predictors of neonatal hyperbilirubinaemia

“…[ 27 ], which reported a cut-off of 2.3 mg/dl, 2.0 mg/dl, 2.0 mg/dl and 3.0 mg/dl respectively, which can be explained by detection of neonatal jaundice at the early stage due to application of transcutaneous bilirubinometry. The cut-off value for CBA by ROC curve analysis was 3.17 g/dl while the values in previous studies were 2.6 g/dl [ 10 ], 3.0 g/dl [ 11 ], 2.75 g/dl [ 25 ], 2.75 g/dl [ 28 ] and 2.95 g/dl [ 29 ]. The difference observed may be due to the small sample size and inclusion of sick and premature neonates in these studies.…”