Prediction of Neonatal Hyperbilirubinemia from Cord Blood Bilirubin and Cord Blood Albumin Ratio in Healthy Term Indian Neonates

Abstract

Background Neonatal jaundice affects 85% term and most of the preterm infants. Unconjugated bilirubin is bound by albumin, which promotes its transit and lessens bilirubin toxicity, thereby serves as early determinant for the risk of pathological hyperbilirubinemia among neonates. Present study was undertaken to know the utility of cord blood bilirubin (CBB), cord blood albumin (CBA), and their ratio at time of birth for the development of significant neonatal hyperbilirubinemia. Objectives To evaluate CBB/CBA ratio at the time of delivery as potential predictive factor for the development of significant neonatal hyperbilirubinemia and compare this with CBB and CBA alone. Study Design Prospective observational analytical study. Participants Total 178 inborn term neonates delivered during 3-month time period (22nd October, 2022−22nd January, 2023). Interventions Cord blood sample was collected at birth for CBA, CBB, and blood grouping/phenotyping. Transcutaneous bilirubin (TCB) measurements were done 12 hourly in all babies for the first 7 days of life/till discharge, and also in the case of development of significant clinical jaundice. For TCB values above cut-off, serum total bilirubin was done and need for phototherapy (PT) decided based on cut offs suggested in AAP 2004 nomograms. Results Cut-off values of CBB and CBA as obtained by the receiver operating characteristic (ROC) curves were 1.98 mg/dL and 3.14 g/dL, respectively. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for CBB were 83.33%, 63.15%, 41.66%, and 92.30%, while for CBA, 41.66%, 71.05%, 31.25%, and 79.41%. CBB/CBA cutoff ratio was 0.630 with 91.66% sensitivity, 86.84% specificity, 68.75% PPV, and 97.05% NPV. Conclusions Compared to CBB and CBA alone, CBB/CBA ratio has greater sensitivity, specificity, PPV, and NPV and it may serve as a better indicator for prediction of pathological hyperbilirubinemia in neonates.