Title: Umbilical Cord Bilirubin-an Early Diagnostic Marker of Significant Neonatal Hyperbilirubinemia
Authors: Dr Ankur Garg, Dr Ajay Kumar Tiwari, Dr Subhash Narang
DOI: https://dx.doi.org/10.18535/jmscr/v5i4.99
Abstract
Background: To study the correlation between umbilical cord blood bilirubin and significant neonatal hyperbilirubinemia in healthy term newborns.
Methods: The cord blood bilirubin estimation was done at birth for all enrolled cases. All the neonates were clinically observed for the development of icterus for 5 days and serum bilirubin level was measured in neonates who developed jaundice on clinical evaluation. Significant hyperbilirubinemia was considered when serum bilirubin levels in term newborns was more than or equal to 12 mg/dl at 24 hours of life, 15 mg/dl at 48 hours, and 17 mg/dl at 72 hours.
Results: Total of 250 neonates were enrolled. Out of these, 27 newborns (10.8%) had significant hyper-bilirubinemia. Mean ± SD cord blood bilirubin level in no hyperbilirubinemia group and hyperbilirubinemia group was 1.657 ± 0.40 mg/dl and 2.607 ± 0.256 mg/dl respectively. There was significant association between cord blood bilirubin level and hyperbilirubinemia (p<0.001). Using Receiver operating characteristic analysis level of cord blood bilirubin at2.2 mg/dl had the high sensitivity (92.6%) and specificity (90.6%) to predict the newborn that would develop significant hyperbilirubinemia with the positive predictive value of 54.3% and the negative predictive value of 99.0%.
Conclusion: There is a positive correlation between umbilical cord blood bilirubin level and significant hyperbilirubinemia. Healthy term neonates with umbilical cord blood bilirubin level of 2.2 mg/dl or more are at higher risk for development of significant hyperbilirubinemia with high sensitivity and specificity. Newborns with umbilical cord bilirubin level < 2.2 mg/dl are at much lower risk and hence can be discharged early.
Keywords: neonatal hyperbilirubinemia, neonatal jaundice, umbilical cord bilirubin.
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