Cord Blood Bilirubin/Albumin Ratio As An Early Predictor For Neonatal Hyperbilirubinemia In Healthy Term Neonates

Abstract

Background

Neonatal jaundice is a common condition with implications for neonatal morbidity and mortality. Screening for hyperbilirubinemia before hospital discharge is crucial for early detection of at-risk newborns. Cord bilirubin and albumin can be valuable early screening indicators for neonatal hyperbilirubinemia. We aimed to evaluate the predictive value of cord blood bilirubin/albumin ratio in identifying healthy term neonates at risk for developing clinically significant neonatal hyperbilirubinemia and its associations with gender, birth weight and mode of delivery.

Materials and Methods

This hospital based prospective observational study was carried out on 120 term healthy neonates, ranging from 37 to 41 weeks of either gender with birth weight >2.5 kgs, without any significant illness or major congenital malformations. The neonates with conditions that could aggravate hyperbilirubinemia (sepsis, respiratory distress syndrome, asphyxia, diabetic mothers, delivered by instrumentation, cephalhematoma) or Rh-negative mother were excluded from the study. Cord blood bilirubin / albumin ratio was analyzed. All infants were monitored daily for jaundice by Kramer staging along with transcutaneous bilirubinometer until the 5th day of life. Infants who were suspected of having bilirubin levels exceeding the physiological limit on any day after birth underwent serum bilirubin measurement. If the serum bilirubin level fell within the interventional range, the babies were taken to the nursery for phototherapy or exchange transfusion. The cord bilirubin/albumin ratio was correlated with babies developing neonatal hyperbilirubinemia requiring either phototherapy or exchange transfusion.

Results

Cord blood bilirubin/albumin ratio cut off value ≥ 0.705 was found significant for predicting hyperbilirubinemia (p value <0.05) having sensitivity of 70.6%, specificity of 92.75 %, PPV 87.8%, and NPV 81.01%.

Conclusion

The present study highlights that the cord blood bilirubin/albumin ratio (a cost-effective and non-invasive test) can help us in identifying those newborns who are at risk of developing significant hyperbilirubinemia.