Abstract

Aims and Objectives: To assess the usefulness of cord bilirubin level as a predictor of occurrence of clinically significant neonatal hyperbilirubinemia in healthy full term neonates. 

Study Setting and Design: prospective cohort study conducted at a pediatric hospital over a period of 9 months.
Materials and Methods:  A prospective cohort study was conducted on 60 consecutively born healthy term babies (gestational age > 37 weeks), irrespective of mode of delivery. The babies were divided into 4 groups A, B, and C, D and E depending upon cord blood bilirubin levels. All the neonates were examined daily clinically for development of clinically significant jaundice from birth to day 8 of life or till discharge from hospital whatever was later. If the clinical examination revealed clinically significant jaundice then immediate laboratory workup was done to determine the severity and type of hyperbilirubinemia. The baby was managed according to standard protocol of management. The data was analyzed and incidence of clinically significant jaundice requiring treatment for hyperbilirubinemia (phototherapy or exchange transfusion) in each group was calculated.

Results: During the study period 84 children were born in our hospital. Out of these 84 newborn babies 60 neonates were included in the study. 24 babies were excluded from the study because either they were preterm, had ABO or Rh incompatibility, birth asphyxia or congenital anomalies. Out of these 60 neonates 32 (53%) were males and 28 (47%) were females with a M: F ratio of 1: 0.88. Amongst the studied neonates 34 (56.66%) babies were delivered by normal vaginal deliveries, 22 (36.66%) were born by lower segment cesarean section (LSCS) and another 4 (6.66%) were delivered by assisted vaginal delivery (AVD). Since prematurity was an exclusion criteria all neonates were full term (> 37 weeks of gestational age). The birth weight of majority of the neonates was in between 2.1-2.5 kg. Cases were divided into 5 Groups depending upon the cord bilirubin level. Group A, B, C, D and E had 25, 13, 9, 5 and 2 newborns respectively. Amongst neonates in group A, 5 (20%) developed clinically significant jaundice, whereas 5 (38.46%) neonates in group B developed clinically significant jaundice. In group C, 5(55.56%) neonates developed clinically significant jaundice. In group D and E 4(80%) and 2 (100%) babies developed clinically significant jaundice.

Conclusion: Our study show that total serum bilirubin in cord blood can be used as a predictor of the development of clinically significant jaundice and need for treatment ( phototherapy or exchange transfusion ) in healthy full term neonates born by any mode of delivery.

Keywords: Cord bilirubin levels, clinically significant jaundice, phototherapy, Exchange transfusion.