UMBILICAL CORD BLOOD BILIRUBIN AS A PREDICTOR FOR NEONATAL HYPERBILIRUBINEMIA

Abstract

Jaundice is a clinical condition that is often present in pediatric practice and constitutes one of the major issues within the neonatal period. It occurs in both the physiological and pathological processes in newborns. The present study was conducted  to verify whether the bilirubin levels found in the cord blood at birth could be indicative of neonatal hyperbilirubinemia among healthy term neonates. 567 term neonates were included in the study and  subjected to a cord blood analysis for serum bilirubin. Further at 72 hrs of life, blood for serum bilirubin was again collected and the two values compared. With Receiver operating characteristic analysis, a cutoff value of cord bilirubin level of ≥1.89mg/dL was determined which had the highest sensitivity (96.36%) to predict the newborns who would develop significant hyperbilirubinemia. In present study, the cord bilirubin level of >1.89 mg/dL had the highest sensitivity (96.36%), and this critical bilirubin level had a very high (99.45%) negative predictive value and fairly low (26.4%) positive predictive value this finding compatible with other studies. The cord bilirubin level of <1.89 mg/dL did not completely exclude the development of significant hyperbilirubinemia; only 0.546% of the newborns with cord bilirubin levels of <1.89mg/dL developed jaundice. A 99.45% negative predictive value in the present study suggests that measurement of cord serum bilirubin can help in identify those newborns who are unlikely to require further evaluation and intervention. Estimating cord bilirubin levels is a simple and non invasive screening test to predict those neonates who are at least risk of developing significant hyperbilirubinemia and unlikely to require further evaluation and intervention.

Key words:  Neonatal jaundice, hyperbilirubinemia, Cord bilirubin, phototherapy