Study of Correlation of Cord Blood Bilirubin with Neonatal Hyperbilirubinemia


Affiliations

  • Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Department of Paediatrics, Nashik, Maharashtra, 422203, India
  • Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik, Maharashtra, 422203, India

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 full-term 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.

Keywords

Cord Bilirubin, Hyperbilirubinemia, Newborns, Neonate

Subject Discipline

Paediatrics

Full Text:

References

Piazza AJ, Stoll BJ. Jaundice and Hyperbilirubinemia in the Newborn. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, editors. Nelson text book of Pediatrics: 19 th Ed. New Delhi; Saunders Elsevier, 2012; 1:603–12.

Penn AA, Enzmann DR, Hahn JS. Kernicterus in full term infant. Pediatrics. 1994 Jun 6; 93:1003–6.

Stevenson DK. Kernicterus in a full-term infant: the need for in creased vigilance. Pediatrics. 1995; 95:799.

Newman TB, Maisles MJ. Does hyperbilirubinemia damage the brain of healthy full-term infants? ClinPerinatol. 1990; 17:331–1335.

Maisles MJ, Newman TB. Kernicterus in Otherwise Healthy Breast-fed Term Newborns. Pediatrics. 1995 Oct; 96:730– 33.

Martin CR, Cloherty JP. Neonatal Hyperbilirubinemia. In: Cloherty JP, Eichenwald EC, Stark AR, editors. Manual of neonatal care: 6th Ed. New Delhi: Wolters Kluwer, 2008; 304–39.

Bahl L, Sharma R, Sharma J. Etiology of Neonatal Jaundice in Shimla. Indian Pediatr. 1994 Oct; 31:1275–78.

Murki S, Majumudhar S, Marwaha N. Risk factors of Kernicterus in term babies with Non haemolytic Jaundice. Indian Pediatr. 2001 Jul; 38(7):757–62.

Moyer VA, Ahn C, Sneed S. Accuracy of clinical judgment in neonatal jaundice. Arch Pediatr Adolesc Med. 2000; 154:391–4.

Seidman DS, Stevenson DK, Ergaz Z. Hospital readmission due to neonatal hyperbilirubinemia. Pediatrics. 1996; 96:727–9.

American Academy of Pediatrics Clinical Practice Guideline and Subcommittee on Hyperbilirubinemia. Management of hyperbilirubinemia in the newborn Infant 35 or more weeks of Gestation. Pediatrics. 2004 Jul 1; 114:297–316.

Bernaldo AJN. Bilirubin dosage in cord blood: could it predict neonatal hyperbilirubinemia? Sao Paulo Med J. 2004 May 6; 122(3):99–103.

Knupfer M, Pulzer F, Gebauer C, Robel-Tillig E, Vogtmann C. Predictive value of umbilical cord blood bilirubin for postnatal hyperbilirubinaemia. Acta Paediatr. 2005 May; 94(5):581–7.

Awasthi S, Rehman H. Early prediction of neonatal hyperbilirubinemia. Indian J Pediatr. 1998; 65:131–39.

Alpay F, Sarici SU, Tosuncuk HD, Serdar MA, Inanc N, Gokcay E. The Value of First Day Bilirubin Measurement in Predicting the Development of Significant Hyperbilirubinemia in Healthy Term Newborns. Pediatrics. 2000 Aug; 106(2):p.e16.

Agarwal R, Deorari AK. Unconjucated Hyperbilirubinemia in Newborn. Indian Pediatr. 2002 Aug 17; 39:30–42.

Randev S, Grower N. Predicting neonatal hyperbilirubinemia using first day serum bilirubin levels. Indian J Pediatr. 2010 Feb; 77:147–50.

Bhutani VK, Johson L, Sivieri EM. Predictive ability of a predischarge hour specific serum bilirubin for subsequent significant hyperbilirubinemia in healthy term and near term newborns. Pediatrics. 1999 Jan; 103:6–14.

Gupta PC, Kumari S, Mullick DN. Icterometer; useful screening tool for neonatal jaundice. Indian Pediatr. 1991 May; 28(5):473–6.

Leite MG, GranatoVde A, Facchini FP, Marba ST. Comparison of transcutaneous and plasma bilirubin measurement. J Pediatr (Rio J). 2007 May-Jun; 83(3):283–6. Epub2007 May 16.

Varvarigou A, Fouzas S, Skylogianni E, Mantagou L, Bougioukou D, Mantagos S. Transcutaneous bilirubin nomogram for prediction of significant neonatal hyperbilirubinemia. Pediatrics. 2009 Oct; 124(4):1052-9. Epub 2009 Sep 28.

Maisels MJ, Ostrea EM Jr, Touch S, Clune SE, Cepeda E, Kring E et al. Evaluation of a new transcutaneous bilirubinometer. Pediatrics. 2004 Jun; 113(6):1628–35.

Palmer DC, Drew JH. Jaundice a 10 year review of 41000 live born infants. Aust Pediatr. 1983 Jun; 19(2):86–9.

Phuapradit W, Chaturachinda K, Anutlamai S. Risk Factors for Neonatal Hyperbilirubinemia. J Med Assoc Thai. 1993 Aug; 76(8):424–8.

Taksande A, Vilhekar K, Jain M, Zade P, Atkari S, Verkey S. Prediction of the development of neonatal hyperbilirubinemia by increased umbilical cord blood bilirubin. Ind Medica. 2005; 9(1):5–9.

Rosenfeld J. Umbilical cord billirubin levels as predictor of subsequent hyperbilirubinemia. J Fam Pract. 1986 Dec; 23:556–58.

Knudsen A. Prediction of the development of neonatal jaundice by increased umbilical cord blood bilirubin. Actapediatr Scand. 1989 Mar; 78(2):217–21.

Rataj J, Kornacka M, Korman E. Usefulness of measuring bilirubin levels in cord blood for predicting hyperbilirubinemia in newborns. Ginekol Pol. 1994 Jun; 65:276–80.

Suchonska B, Wielgos M, Bobrowska K, Marianowiski L. Concentration of bilirubin in the umbilical blood as an indicator of hyperbilirubinemia in newborns. Ginekol pol. 2004 Oct; 75(10):749–53.

Nahar Z, Shahidukkah MD, Mannan A, Dey SK, Mitra U, Selimuzzaman SM. The value of umbilical cord blood bilirubin measurement in predicting the development of significant hyperbilirubinemia in healthy Newborn. Bangladesh J Child Health. 2009; 33(2):50–4.

Sun G, Wang YL, Liang JF, Du LZ. Predictive value of umbilical cord blood bilirubin level for subsequent neonatal jaundice. Zhonghua ErKeza Zhi. 2007 Nov; 45(11):848–52.

Satrya R, Effendi SH, Gurnida DA. Correlation between cord blood bilirubin level and incidence of hyperbilirubinemia in term newborns. Paediatrica Indonesiana 2009; 49(6):349–54.


Refbacks

  • There are currently no refbacks.