Umbilical Cord Blood Bilirubin Level Measurement in Predicting the Development of Significant Hyperbilirubinemi

Authors

  • Eshwara Chary
  • Bharadwaj N
  • Pavan Kumar P
  • Vivekand N
  • Sailaja V
  • Harika B

Abstract

Objectives: This prospective study was undertaken to identify the newborns at risk for developing significant hyperbilirubinemia using cord blood serum bilirubin levels. Methodology: This was prospective study with total of 282 healthy term newborns delivered at MNR Hospital, were included in study with birth weight more than 2,500 grams during one year period from March 2013 to March 2014. Soon after delivery cord blood was sent for serum bilirubin analysis. The data was analyzed using t-test, ROC curve and chi test and was considered statically significant, if value is P<0.05. Results: In total 282 children, 51 developed significant hyperbilirubinemia (18.09%). There were no significant differences between the cases who did and who did not develop significant hyperbilirubinemia with respect to various factors that may be associated with the risk of hyperbilirubinemia such as birth weight, type of delivery, gestational age, maternal age, gender, and APGAR value P > 0.05, while in cord bilirubin level there is highly significant difference P <0.05. In our study on the amount of umbilical cord bilirubin cut off point of 2 mg/dl had good sensitivity (94.12), specificity (90.9%), positive predictive value (69.57%) and negative predictive value (98.59%). Conclusion: The present study led to the conclusion that the bilirubin levels that were equal to or greater than 2 mg/100 ml umbilical cord blood can predict significant hyperbilirubinemia with high negative and positive predictive values and high levels of sensitivity and specificity.

References

Bhutani VK, Johnson L. Prevention of severe neonatal hyperbilirubinemia in healthy infants of 35 or more weeks of gestation: implementation of a systems-based approach. J Pediatr (Rio J) (2007). 83(4): 289-93.

Gonçalves A, Costa S, Lopes A, Rocha G, Guedes MB, Centeno MJ, et al. Prospective validation of a novel strategy for assessing risk of significant hyperbilirubinemia. Pediatrics (2011). pp. 127-26.

Bernaldo AJN, de Mattos Segre CA. Bilirubin dosage in cord blood: could it predict neonatal hyperbilirubinemia? Sao Paulo Med J (2004). 122(3): 99-103

Gholitabar M, McGuire H, Rennie J, Manning D, Lai R. Clofibrate in combination with phototherapy for unconjugated neonatal hyperbilirubinaemia (Review). Cochrane Database of Systematic Reviews (2012). 12:CD009017. DOI:10.1002/14651858.CD009017.pub2

Alpay F, Sarici SÜ, Tosuncuk HD, Serdar MA, Inanç N, Gökçay E. The value of first-day bilirubin measurement in predicting the development of significant hyperbilirubinemia in healthy term newborns. Pediatrics (2000). 106: e16.

Escobar GJ, Greene JD, Hulac P, Kincannon E, Bischoff K, Gardner MN, et al. Rehospitalisation after birth hospitalisation: patterns among infants of all gestations. Arch Dis Child (2005). 90: 125-31.

Gourley GR. Bilirubin metabolism and kernicterus. Adv Pediatr (1997). 44: 173-229. [8] Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation. American Academy of Pediatrics. Clinical Practice Guideline. Pediatrics (2004). 114: 297.

Ahmadshah F, Anahita AG, Ashraf M, Azam K, Mehrieh R. Does umbilical cord bilirubin level have predictive value in pathologic neonatal hyperbilirubinemia? Iran J Neonatol (2013). 4(1): 32- 35.

Al-Gabban NI, Nadhim Abd H, Ahmed Abd E. Unconjugated neonatal hyperbilirubinemia: evaluation and treatment. Iraqi J Comm Med (2010). 23(3): 165-68.

Bhutani VK, Gourley GR, Adler S, Kreamer B, Dalin C, Johnson LH. Noninvasive measurement of total serum bilirubin in a multiracial predischarge newborn population to assess the risk of severe hyperbilirubinemia. Pediatrics (2000). 106: e17.

Lock M, Ray JG. Higher neonatal morbidity after routine early hospital discharge: Are we sending newborns home too early? Can Med Assoc J (1999). 161(3): 249.

Shahidullah ZN, 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): 50-54.

Narang A, Gathimala G and Kumar P. Neonatal jaundice: an analysis of 551 cases. Indian Paediatrics (2001). 68: 977-80.

Rosenfeld J. Umbilical cord bilirubin levels as a predictor of subsequent hyperbilirubinemia. J Fam Pract (1986). 23(6): 556-58.

Knudsen, A. Prediction of the development of neonatal jaundice by increased umbilical cord blood bilirubin. Acta Paediatrica (1989). 78: 217-21.

Trivedi DJ, Markande DM, Vidya BU, Bhat M, Hegde PR. Cord serum bilirubin and albumin in neonatal hyperbilirubinemia. Int J Int Sci Inn Tech Sec A (2013). 2(2): 39-42.

Gatea SK. Cord bilirubin level as predictor for Newborns at Risk for post natal Hyperbiliruinemia. Kufa Med J (2009). 12(2): 109-117. [19] Knüpfer M, Pulzer F, Gebauer C, Robel-Tillig E, Vogtmann C. Predictive value of umbilical cord blood bilirubin for postnatal hyperbilirubinaemia. Acta Paediatrica (2005). 94: 581-87.

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Published

2014-11-17

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Original Research