Predictive value of umbilical cord blood bilirubin and albumin for significant hyperbilirubinemia in ABO incompatibility

Abstract

Introduction: ABO incompatibility is the most common cause of hemolytic disease of the newborn with approximately 15% of live births at risk. The objective of this study wasto estimate the levels of bilirubin and albumin in cord blood and determine their relationship with the occurrence of neonatal hyperbilirubinemia in ABO incompatibility.

Methods: Design: Prospective study.

Study settings: Raja Mirasudhar Hospital, Thanjavur.

Participants: Healthy term neonates (n-92) born to O+ve mothers.

Control: neonates (n-55) with blood group O+ve. Case:neonates (n-37) with blood group A+ve orB+ve.

Procedure: Umbilical cord blood was collected from newborns and serum albumin and bilirubin levels estimated. The babies were followed-up daily for development of jaundice and serum bilirubin was measured in all newborns at 24 and 72 hours of life.

Result: The mean serum total bilirubin and albumin in umbilical cord blood were 1.596+0.46 mg/dland 3.587 + .65g/dl in control group and 1.995+1.16 mg/dl and 3.559 + .64g/dl in case group respectively. Umbilical cord serum albumin level of< 3.15 g/dl predicts the development of significant hyperbilirubinemia with a sensitivity of 76.5%, specificity of 78.7% and an accuracy of 77.6%. Umbilical cord serum total bilirubin of >1.85 mg/dl predicts the development of significant hyperbilirubinemia with a sensitivity of 70.6%, specificity of 82.7% and an accuracy of 76.7%.

Conclusion: In ABO blood group incompatibility, neonates with umbilical cord blood total bilirubin >1.85 mg/dl and albumin <3.15 g/dl need close follow up to watch for development of significant hyperbilirubinemia while those babies with umbilical cord total bilirubin <1.85 mg/dl and albumin>3.15 g/dl can be safely discharged early.