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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 16  |  Issue : 2  |  Page : 295-302

A comparative study of cord blood bilirubin and albumin as a predictor for neonatal jaundice in term newborns


1 Department of Biochemistry, Santosh Medical College and Hospital, Ghaziabad, Uttar Pradesh, India
2 Department of Paediatrics, Santosh Medical College and Hospital, Ghaziabad, Uttar Pradesh, India

Date of Submission20-Feb-2021
Date of Decision18-Mar-2021
Date of Acceptance29-Mar-2021
Date of Web Publication18-Oct-2021

Correspondence Address:
Dr. Juhi Aggarwa
Department of Biochemistry, Santosh Medical College and Hospital, Ghaziabad - 201 009, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdmimsu.jdmimsu_80_21

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  Abstract 


Background: Neonatal hyperbilirubinemia (NH) is the commonest abnormal physiological finding during the 1st week of life. More than two-third of newborn babies develop clinical jaundice. The clinical finding such as yellowish discoloration of the skin and sclera in newborns is because of accumulation of unconjugated bilirubin. In most infants, however, unconjugated hyperbilirubinemia is a normal physiological phenomenon. Aim of the Study: The aim of the study was to predict the development of NH at birth in term newborns using cord blood bilirubin and albumin as a risk predictor. Materials and Methods: The present cross-sectional study was performed on 150 healthy term newborns, i.e., both males (n = 84) and females (n = 66) with gestational age >38 weeks delivered by caesarian section from the Department of Obstetrics and Gynaecology and Department of Pediatrics and Department of Biochemistry, Santosh Medical College, Ghaziabad. Results: Cord serum albumin (CSA) level of ≤2.8 g/dl cutoff value is chosen based on the receiver operating characteristics (ROC) analysis. Shows the neonates who developed NH, 95.2% of these cases had CSA level ≤2.8 g/dl (20/21). If CSA level ≤2.8 g/dl, 28.9% probability of developing NH, and if CSA >2.9 g/dl, then 97.7% chance of not developing NH. Similarly, if CSA level ≥3.4 g/dl, nil or 0% chance of developing NH. Hence, CSA level ≤2.8 g/dl can be considered as critical value or risk factor for the development of NH, whereas newborn with CSA level ≥3.4 g/dl is safe for early discharge. Conclusion: Increasing incidence of kernicterus in healthy term neonates as Kernicteus is the chronic sequelae of acute bilirubin encephalopathy. Hyperbilirubinemia is one of the most common causes for readmission of the newborns. Incidence of kernicterus is unknown. Hence, defining a certain bilirubin level as physiological can be misleading and potentially dangerous. NH is a potentially correctable and kernicterus is preventable.

Keywords: Cord blood bilirubin and albumin, neonatal hyperbilirubinemia, Neonatal Jaundice


How to cite this article:
Huda WM, Sharma P, Aggarwa J, Agrawal A. A comparative study of cord blood bilirubin and albumin as a predictor for neonatal jaundice in term newborns. J Datta Meghe Inst Med Sci Univ 2021;16:295-302

How to cite this URL:
Huda WM, Sharma P, Aggarwa J, Agrawal A. A comparative study of cord blood bilirubin and albumin as a predictor for neonatal jaundice in term newborns. J Datta Meghe Inst Med Sci Univ [serial online] 2021 [cited 2021 Dec 4];16:295-302. Available from: http://www.journaldmims.com/text.asp?2021/16/2/295/328481




  Introduction Top


Neonatal hyperbilirubinemia (NH) is the most common abnormal physiological finding during the 1st week of life. More than two-third of newborn babies develop clinical jaundice. The clinical finding like yellowish discoloration of the skin and sclera in newborns is because of accumulation of unconjugated bilirubin. In most infants, however, unconjugated hyperbilirubinemia is a normal physiological phenomenon.[1]

NH occurs in nearly 60% of term and 80% of preterm neonates during 1st week of life.[2] Excessive bilirubin production, inability to handle this excess bilirubin by the newborn”s immature liver enzymes, poor colonization of the intestinal bacteria, increased brush border beta-glucuronidase activity and increased enterohepatic circulation together contribute to this increased incidence of hyperbilirubinemia in neonates. Nearly 6.1% of term newborns have a serum bilirubin more than 12.9 mg %. Serum bilirubin more than 15 mg % is found in 3% of normal term newborns. NH is a cause of concern for the parents as well as the pediatricians.[3]

Globally, neonatal jaundice (NNJ) was estimated to account for ~8 deaths per 100,000 among under 5 (95% uncertainty interval [UI]: 7–9) in 2016. It was ranked 16th from over 100 possible causes of under-5 mortality consistently since 1990. In the early-neonatal period (0–6 days).

NNJ accounted for 1309.3 deaths per 100,000 (95% UI: 1116.8–1551.3) and ranked seventh globally. The burden was the maximum in countries with low-middle or low quintiles of sociodemographic index values,[4] especially in Sub-Saharan Africa and South Asia, where NNJ was the seventh and eighth leading cause of mortality, respectively.[4],[5]

ABO incompatibility is found in about 15% of pregnancies. But only <1% of these babies develop significant hyperbilirubinemia that requires treatment. Very high bilirubin levels and kernicterus occur in ABO incompatible healthy term newborns even without significant hemolysis and positive DAT.[6]

Early postnatal discharge within 48 h of birth for healthy term newborns has become common nowadays. This reduction in hospital stay enables the family to start their daily routine at the earliest and also decreases the economic burden on them in a developing country like India. Furthermore, it was found that mothers who were discharged from the hospital earlier were significantly more satisfied and had better exclusive breastfeeding rates than the late discharge group by Carty EM and Bradley CF in their study, “A randomized, controlled evaluation of early postpartum discharge.”[7] They also found that those mothers in the late discharge group scored higher on measures of depression and lower in confidence. However, NNJ, the most common cause for readmission of newborns, goes unnoticed in those discharged early.[8],[9] American Academy of Pediatrics recommends mandatory follow-up visit after 48–72 h of discharge for all neonates who were initially discharged before 48 h of life to look for any significant jaundice and other problems.[10],[11] However, such follow-up is not possible in all cases in our country due to issues such as noncompliance and ignorance. Kernicterus is a tragic and irreversible event, resulting in mortality and severe long-term morbidity. Kernicterus is essentially preventable as phototherapy (PT) has a definite risk-reducing potential for bilirubin levels over 20 mg/dl.[12],[13]

Many conditions and factors have been observed to increase the risk of the development of significant hyperbilirubinemia in newborns necessitating medical attention. Some of them include blood group incompatibility, cephalhematoma, significant bruising, injuries, history of NNJ in previous sibling, and predischarge total serum bilirubin (TSB) or TcB in high-risk level. Although understanding of NH has improved significantly in recent years, it is still not possible to precisely predict those babies at risk of developing significant hyperbilirubinemia.

Since albumin binds with bilirubin in equimolar concentrations, free bilirubin levels in serum increase in conditions with low serum albumin concentration. Similar correlations have been discussed between umbilical cord blood bilirubin and NH as well for many years now.

Since then, many researchers have studied the correlation between the umbilical cord blood bilirubin and albumin in predicting significant NH. However, no study has established a single cutoff for umbilical cord blood bilirubin and albumin, especially in cases of ABO incompatibility, to allow us to predict at birth, those babies who are going to develop significant hyperbilirubinemia requiring therapeutic intervention.

Thus, the present study was conducted to evaluate the predictive ability of the umbilical cord blood bilirubin and albumin in the development of significant NH.

Fetal bilirubin metabolism

In fetus, most of the unconjugated bilirubin formed gets cleared into the maternal circulation by the placenta, whereas the formation of conjugated bilirubin is limited in the fetus because of decreased fetal hepatic blood flow, decreased hepatic ligand in, and decreased uridine diphospho-glucuronyl-transferase (UDPG-T) activity. UDPG-T activity is detectable at 18–20 weeks. UDPG-T levels in full-term and preterm neonates are generally <0.1% of adult values. Adult value of this enzyme activity is demonstrable only by 6–14 weeks of postnatal life.[14]

Bilirubin is detected in normal amniotic fluid as early as 12 weeks of gestation but usually disappears by 36–37 weeks.[4]

During the neonatal period, the metabolism of bilirubin shows the transition from the fetal stage to the adult stage. During the fetal stage, the principal route of elimination of the lipid-soluble, unconjugated bilirubin is the placenta, whereas during the adult stage, the water-soluble conjugated form is excreted into the biliary system and gastrointestinal tract from hepatic cells.[15]

Complications of neonatal jaundice

The most important complication of NNJ is bilirubin encephalopathy. Bilirubin encephalopathy refers to the clinical manifestations of the effects of bilirubin on the central nervous system (CNS), whereas kernicterus refers to the neuropathological changes characterized by pigment deposition in specific areas like basal ganglia, pons and cerebellum within the CNS.[16]

Bilirubin encephalopathy is a multifactorial process. It requires a critical level of free bilirubin, it's access across the blood–brain barrier, and the presence of susceptible nerve cells within the brain. The severity and duration of hyperbilirubinemia, the structural maturity, the binding capacity of albumin, the cell membrane composition, and metabolic state as well as physiological environment probably all play a critical role in the development of neurodysfunction.[15]

Chronic bilirubin encephalopathy (kernicterus)

Kernicterus is defined as bilirubin-induced brain dysfunction.[16] This term was coined in 1904 by Schmorl. It occurs in hyperbilirubinemia and results from the accumulation of bilirubin in the grey matter of CNS potentially causing irreversible neurological damage. It is characterized by athetosis, athetoid cerebral palsy, partial or complete high frequency sensorineural hearing loss, paralysis of upward gaze, dental dysplasia, and intellectual deficits.[4]

Evaluation and diagnosis of neonatal jaundice

NH affects nearly 60% of term and 80% of preterm neonates during the 1st week of life. 6.1% of well-term newborn show a serum bilirub in over 12.9 mg %. Serum bilirubin above15 mg % is found in around3% of normal term newborns.

Dermal staining of bilirubin may be used as a clinical guide to assess the level of jaundice originally described by Kramer.[17]

The newborn should be examined in good daylight. The skin should be blanched with digital pressure, and the underlying color of skin and subcutaneous tissue should be noted. A rough guide for the level of dermal staining with the level of bilirubin is included in [Table 1].
Table 1: A rough guide for level of dermal staining with level of bilirubin

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Aims and objectives

Aim

The aim of the study was to predict the development of NH at birth in term newborns using cord blood bilirubin and albumin as a risk predictor.

Objectives

  • To analyze cord blood bilirubin and albumin in term newborns
  • To find out the correlation of cord blood bilirubin and albumin with NNJ.



  Materials and Methods Top


The present cross-sectional study was performed on 150 healthy term newborns, i.e., both males (n = 84) and females (n = 66) with gestational age >38 weeks delivered by cesarean section from the Department of Obstetrics and Gynaecology and Department of Pediatrics and Department of Biochemistry, Santosh Medical College, Ghaziabad. The necessary approval was obtained to conduct the study from the Santosh Medical College and Hospital, ethical committee, Ghaziabad. Patients were given an explanation regarding the intention of the study, and informed written consent was obtained, confidentiality about their results was assured. The period of the study was April 2019 to May 2020.

Sample size is calculated using the following formula:



Where z = 1.96 at level of confidence of 95%

e = 0.7 (acceptable margin of error)

σ=4.18 (standard deviation [SD] of TSB at day 3 frompreviousstudy)[18]

n = 137, hence I have taken 150 cases as sample size for my study.

Inclusion criteria

Term newborns (gestational age >38 weeks) of both the gender. Birth weight >2.5 kg, APGAR score ≥7/10 at 1 min, hospital stay of 5 days (Only lower segment caesarean section taken).

Exclusion criteria

Preterm babies, rhincompatibility, ABO incompatibility, PROM for >18 h, neonatal sepsis, and respiratory distress.

Method of collection of data

An informed consent was obtained from the parents of the newborn before enrolling them in the study. Demographic profile and relevant information were collected using structured pro forma by interviewing the mother and from mother's case sheet. Clinical evaluation of both the mother and the neonate was performed in the hospital. Gestational age was assessed by New Ballard score (if last menstrual period not sure). Cord serum bilirubin and cord blood albumin level was estimated at birth. TSB estimation was done at 72–120 h of age. All the babies were followed up daily for first 5 postnatal days, and babies were daily assessed for NH and it severity.

Laboratory investigation

Cord blood (2 ml) was collected from placental side after its separation at the time of delivery under aseptic conditions in plain vacutainer vials and cord serum bilirubin level and Cord blood albumin levels were measured by fully automated analyser roche. Venous blood samples were collected from the baby at 72–120 h of life. These samples were subjected to total serum bilirubin measurement.

Statistical analysis

The collected data were analyzed with IBM. SPSS statistics software 22.0 Version. To describe about the data descriptive statistics, frequency analysis and percentage analysis were used for categorical variables and the mean and S. D were used for continuous variables. To find the significant difference between the bivariate samples in independent groups, the unpaired sample t-test was used. The receiver operator characteristic (ROC) curve analysis was used to find the cutoff with sensitivity and specificity for the efficacy of tools. To find the significance in categorical data, Chi-square test was used. If the expected cell frequency is <5 in 2 × 2 tables, then the Fisher's Exact was used. In all the above statistical tools, the probability value of 0.05 is considered as significant level.


  Observation and Results Top


The following results were made from the study. The study was conducted on total of 150 newborns after obtaining a written consent from the parents. Pro forma was filled for each newborn.

[Table 2] and [Figure 2] show the distribution of cases as per gravida and parity status of patients. Maximum number of patients (47.3%) belong to the group G2P1 followed by the group G1P0 (45.3%).
Table 2: Distribution of cases on the basis of gravida and parity

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Figure 1: Mortality ranking for NNJ

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Figure 2: Bar diagram showing distribution of cases on the basis of gravidaand parity

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[Table 3] shows the mode of delivery in the study group. All the newborns in the study group were delivered by caesarian.
Table 3: Mode of delivery

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[Table 4] and [Figure 3] shows the gender distribution of newborn in the study group; 84 (56%) were male and 66 (44%) were female newborns. [Table 5] and [Figure 4] shows the maternal weight document in last trimester or just before delivery was collected from case sheet. Maternal weight in the study group is concentrated between 60–70 kg (43.3%) and 70–80 kg (32.7%).
Table 4: Gender distribution

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Figure 3: The pie chart shows the gender distribution in percentage

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Table 5: Maternal weight

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Figure 4: The bar diagram shows the maternal weight

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[Table 6] and [Figure 5] show the distribution of birth weight among the studied newborns. <2.5 kg birth weight babies were excluded. Moreover, among the study group, 91 (68.9%) newborns had birth weight between 2.5 and 3.0 kg. Mean birth weight among the study cohort is 3.16 kg.
Table 6: Birth weight (kg) distribution in study group

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Figure 5: The bar diagram shows the birth weight (kg) distribution in study group

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[Table 7], [Table 8], [Table 9], [Table 10] and [Figure 6] shows the distribution of study cohort into groups based on cord albumin level measured at birth. Group A consists of 69 newborns constituting to 46.0% of the study cohort, whereas Group B consists of 45 newborns (30.0%) and Group C consists of 36 newborns (24.0%) of study cohort.
Table 7: Grouped based on cord serum albumin (g/dl) level

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Table 8: Bilirubin profile of (zero, 3rd, and 5th) postnatal days

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Table 9: Association of neonatal hyperbilirubinemia (≥17 mg/dl) and the critical cord bilirubin level (≥2.15 mg/dl)

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Table 10: Diagnostic statistics

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Figure 6: The bar diagram shows the grouped based on cord serum albumin (g/dl) level

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This present study infers that the cord serum bilirubin levels of the babies with neonatal hyerbilirubinemia (≥17 mg/dl) is significantly higher than the babies without hyperbilirubinemia bilirubin profile in the 0 days, 3rd days, and 5th days of postnatal life infers that babies with NH have significantly higher bilirubin levels compared to babies without hyperlilirubinemia.

Cord bilirubin level of ≥2.15 mg/dl cutoff value is chosen based on the receiver operating characteristics (ROC) analysis. In the present study, cord serum bilirubin of ≥2.15 mg/dl having the sensitivity 90.4%, specificity 62.7%, positive predictive value 28.3% and the negative predictive value 97.5% in prediction of neonatal hyperbilirubinemia.(P = is 0.001). Sothecordbilirubin level of ≥2.15 mg/dl can be used as an early predictor of NH.

[Table 11] and [Figure 8] shows the newborn in the study cohort those developed significant NH requiring PT treatment. Twenty out of 150 (14.0%) newborn required PT.
Table 11: Distribution of phototherapy requirement for neonatal hyperbilirubinemia in the study

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Figure 7: Cord serum bilirubin level as a risk factor to predict neonatal hyperbilirubinemia

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Figure 8: Showing distribution of phototherapy requirement for neonatal hyperbilirubinemia in the study

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[Table 12] and [Figure 8] show the correlation of variables such as gender and cord albumin level with newborns who developed significant NH requiring PT. Statistical significance is seen in cord albumin levels only (P < 0.001), and there was no statistical significance with other variables.
Table 12: Correlation of clinical variable with need for phototherapy

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Cord serum albumin (CSA) level of ≤2.8 g/dl cut off value is chosen based on the receiver operating characteristics (ROC) analysis. [Table 12] and [Figure 6] Shows the neonates who developed NH, 95.2% of these cases had CSA level ≤2.8 g/dl (20/21). If CSA level ≤2.8 g/dl, 28.9% probability of developing NH and if CSA >2.9 g/dl, then 97.7% chance of not developing NH. Similarly if CSA level ≥3.4 g/dl, nil or 0% chance of developing NH. Hence CSA level ≤2.8 g/dl can be considered as critical value or risk factor for development of NH. Whereas newborn with CSA level ≥3.4 g/dl is safe for early discharge [Figure 1], [Figure 7], [Figure 9] and [Figure 10] and [Table 13].
Figure 9: Correlation of clinical variable with need for phototherapy

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Figure 10: Cord serum albumin level as a risk factor to predict neonatal hyperbilirubinemia

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Table 13: Diagnostic statistics

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  Discussion Top


There is a concern about increasing incidence of kernicterus in healthy term neonates as Kernicteus is the chronic sequelae of acute bilirubin encephalopathy. Hyperbilirubinemia is one of the most common causes for readmission of the newborns. Incidence of kernicterus is unknown. Hence, defining a certain bilirubin level as physiological can be misleading and potentially dangerous. NH is a potentially correctable and kernicterus is preventable.

NH is one of the most common causes for the readmission of the newborns. The need for early detection of hyperbilirubinemia in the early discharged newborns from the hospital is there fore important.

Knowledge of the neonates at risk for developing jaundice allows simple bilirubin reducing methods to be implemented before bilirubin reaches critical levels.

In this present study, we assessed the CSA and bilirubin level as a tool for screening for the risk of subsequent neonatal hyperbilirubinimia.

In the present study association between the NH and the mode of delivery was studied. 150 cases with cesarean section delivery 21 developed (serum bilirubin ≥17 mg/dl).

Taksande et al.,[19] in their study on 200 newborns, 11 cases of 114 vaginal delivery and 8 cases of 66 caesarean section developed significant hyperbilirubinemia. With P value of 0.527 showed no correlation between the mode of delivery and NH. Satrya et al.,[20] 2009, in a study on 88 newborns, with cutoff NH of ≥14.9 mg/dl showed that there is no association (P 0.885) between the mode of delivery and neonatal hyperbilirubinemia.

In the present study, study group is uniformly distributed with 84 male and 66 female babies. There is no significant correlation in the TSB levels and the sex of the newborn. Hence, the present study infers that the NH (≥17 mg/dl) is independent of the sex of the newborn.

Maisal et al.,[12] 1998, showed in a study consisting of 29934 infants, factors associated with readmission for jaundice. Male sex in the study group is 74.8% compared to control with 49.6%, with P value 0.007, showing that male sex has more risk of readmission for NH.

Taksande et al.,[19] 2005, in a study on 200 neonates with 82 males and 118 females, 8 males and 11 females have serum bilirubin level of (≥17 mg/dl) with P value of 0.323. Hence, they found no correlation between the sex of the newborn and the NH (≥17 mg/dl).

Satrya et al.,[20] 2009, showed a significant correlation between the sex of the newborn and NH with P < 0.05. Off 88 newborns 21 develop hyperbilirubinemia, 16 were males and 5 females.

In the present study, on receiver operating characteristics (ROC) analysis, critical cord bilirubin level (≥2.15 mg/dl) with high sensitivity and high specificity is selected. The probability that a neonate with cord bilirubin ≥2.15 mg/dl would later become hyperbilirubinemia (positive predictive value) was 28.3%. The negative predictive value, the probability of nonhyperbilirubinemia given a cord bilirubin lower than 2.15 was 97.5%. If a neonate become hyperbilirubinemic, the probability that the cord bilirubin was ≥2.15 mg/dl was 92.4% (sensitivity). Given a nonhyperbilirubinic child, the probability that the cord bilirubin was <2.15 mg/dl was 62.7% (specificity).

Taksande et al.,[19] 2005, showed that the cord bilirubin level >2 mg/dl has a sensitivity 89.5%, specificity 85%, negative predictor value of 98.7%, and positive predictive value of 38.8% in correlation with the present study.

Shahidukkah ZN et al.,[22] 2009, showed that the cord bilirubin level >2.5 mg/dl has a sensitivity 77%, specificity 98.6%, negative predictor value of 96%, and positive predictive value of 38.8% in correlation with the present study.

Bernaldo and Segre,[23] in 2005, showed that the cutoff point for unconjugated bilirubin in cord blood was ≥2.0 mg/dl the probability that the newborn would need PT was 53%. When cord blood bilirubin was 2.5 mg/dl, the probability needing PT was 72%. When the level was 3.0 mg/dl, the probability of needing treatment was 86%, and if it was 3.5% mg/dl, the probability went up to 93%. Sun et al.[24] 2007, Satrya et al.[20] 2009, studies are in correlation with the present study.

Rostami et al.[25] 2005, on their study to identify healthy newborns at risk for developing significant hyperbilirubinemia by measuring bilirubin level in cord blood in 643 full-term infants. Serum bilirubin level was obtained on umbilical cord serum and on day 3 and 5 of age. The total bilirubin ≥239 mol/l (14 mg/dl) was defined as significant hyperbilirubinemia. They concluded that cord serum bilirubin level cannot identify newborns with subsequent significant hyperbilirubinemia.

Sahu et al.[26] study, 2011, showed that 70% (14/20) newborn who developed significant NH had CSA level <2.8 g/dl, 30% (6/20) newborn had CSA level 2.9–3.3 g/dl and none of newborns with CSA level >3.4 g/dl developed NH. There is Statistical significance noted between CSA with development of NH (P < 0.001).

Trivedi et al.,[21] 2013, studied a total of 605 newborns and 205 newborns developed significant NH in study group. Study group were divided into 3 groups based on CSA levels <2.8 g/dl, 2.9–3.5 g/dl, and >3.5 g/dl. In group 1, 58.35% (120/205); group 2, 28.78% (59/205) and group 3, 12.68% (26/205) developed NH. There is the statistical significance with CSA level and neonatal hyperbilirubinemia, with P < 0.05.

In the present study, 150 newborns included and 21 newborns developed NH. This study are grouped into Group A, Group B, Group C, based on CSA level ≤2.8 g/dl, 2.9–3.3 g/dl and ≥3.4 g/dl respectively. In Group A, 95.2% (20/21); Group B, 4.8% (1/20), and Group C, 0.0% developed NH requiring PT.

The present study results correlated well with Shau et al. and Trivedi et al.'s study. Thus CSA level appears risk indicator in predicting NH. Hence, this study indicates that CSA level ≤2.8 g/dl is high risk factor for future development of NH and CSA level ≥3.4 g/dl is probably safe for early discharge.


  Conclusion Top


Hyperbilirubinemia is one of the most common problems encountered in neonatal wards. In the present study infants with NH (≥17 mg/dl) had significant higher levels of cord blood bilirubin than neonates with serum bilirubin of <17 mg/dl. So cord blood bilirubin can be used an effective tool for identification of neonates who are at higher risk of NH, so pediatricians can plan an effective follow up programme for that group.

From the present study, cord bilirubin level of ≥2.15 mg/dl has a correlation with incidence of significant hyperbilirubinemia in term newborns. So this ≥2.15 mg/dl of cord bilirubin level could predict the development of significant hyperbilirubinemia. Furthermore, CSA level of ≤2.8 g/dl has a correlation with incidence of significant hyperbilirubinemia in term newborns. So this ≤2.8 g/dl of CSA level can be used as risk indicator to predict the development of significant hyperbilirubinemia, whereas CSA level ≥3.4 g/dl is considered safe, as none of neonates developed in this group had significant hyperbilirubinemia.

Hence, we can conclude that routine estimation of cord serum bilirubin and cord serum bilirubin is recommended in all term newborns in hospital delivery to identify high-risk cases of NNJ that will enable the pediatricians to plan an effective follow-up program for such cases and thereby prevent complications. Cord serum bilirubin of value ≤2.15 mg/dl and CSA of level ≥3.4 g/dl can be considered safe for early discharge and those with cord serum bilirubin ≥2.15 mg/dl and CSA ≤2.8 g/dl must be considered under regular follow-up.

There is no statistically significant association between the NH and Oxytocin administration in mother for induction of labour. CSA level of ≤2.8 g/dl has a sensitivity of 95% and specificity of 64.44%, positive predictive value 24.68% and negative predictive value of 98.97% in predicting the risk of neonatal hyperbilirubinemia. Hence, we can conclude that Cord serum bilirubin of value ≤2.15 mg/dl and cord serum albumin of level ≥3.4 g/dl can be considered safe for early discharge and those with cord serum bilirubin ≥2.15 mg/dl, and CSA ≤2.8 g/dl must be considered under regular follow-up.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9], [Table 10], [Table 11], [Table 12], [Table 13]



 

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