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

Abstract

Introduction: Neonatal jaundice or hyperbilirubinemia is a cause of concern for parents and pediatricians, with more than 60% being affected by this condition in the first few weeks. Prediction of high risk neonates for hyperbilirubinemia will help in developing appropriate follow-up programs for managing the condition. It will also help in reducing duration of hospital stay for low-risk neonates.

Objective: To estimate the predictive value of umbilical cord blood bilirubin level for the development of significant hyperbilirubinemia in healthy, full term neonates.

Methodology: A prospective study on 450 healthy full tem newborns was undertaken in the postnatal care ward of a tertiary level teaching hospital. The study focused on predictive ability of cord blood bilirubin levels and subsequent development of hyperbilirubinemia.

Results: Clinically significant hyper bilirubinemia was detected in 254 out of 450 newborns (56%) neonates. Majority of participants had cord blood bilirubin levels ranging from 1.5-2.4mg/dl. Only 1.3% (3 neonates) had levels ≥3 mg/dl. Majority of newborns in our study (60%) had an intermediate risk of developing hyper bilirubinemia, and only 1.3% (31) belonged to the high risk category on stratifying risks. Cord bilirubin cut off value of 1.9 mg/dl predicted subsequent hyperbilirubinemia with sensitivity of 91.8% and specificity of 52.4%.

Conclusion: Study highlights that risk stratification is an excellent method of tracking newborns with hyperbilirubinemia as newborns with hour-specific bilirubin value in low risk zone have reduced risk of developing subsequent significant hyperbilirubinemia. The probability of developing this condition in neonates was not significantly different in males and females.