Details
Category: Volume 07 Issue 04 April 2019
Hits: 1358

Title: Evaluation of critical cord blood bilirubin level as a predictor of significant hyperbilirubinemia in term newborns

Authors: Hamar Bathew Buam, Namganglung Golmei, Ch Shyamsunder Singh, M Meenakshi, Ch. Mangi, N Nabakishore

 DOI: https://dx.doi.org/10.18535/jmscr/v7i4.103

Abstract

Background: Jaundice is the commonest abnormal physical finding during first week of life. Over two-thirds of newborn babies develop clinical jaundice and by adult standards, almost all newborn babies are jaundiced. In term babies, physiological jaundice appears between 36-72 hours of age while pathological jaundice appears within 24 hours of life. Serum total bilirubin concentrations have been defined as nonphysiologic if the concentration exceeds 5 mg/dl on the first day of life in a term neonate, 10 mg/dl on the second day, or 12 to 13 mg/dl thereafter.

Objectives: To evaluate the critical cord blood bilirubin level as a predictor of significant hyperbilirubinemia and the occurrence of hyperbilirubinemia in term newborns.

Materials and Methods: In a cross-sectional study conducted over 2 years in a tertiary care referral hospital in Manipur, India, 300 newborns without complications were selected and the cord blood bilirubin estimation was done at birth and serum bilirubin at 48 hours of life.

Results: There were no significant differences between the cases who cord bilirubin level < 3 mg/dl and > 3 mg/dl with respect to various factors that may be associated with the risk of hyperbilirubinemia, such as gender, gestational age, birth weight and oxytocin used. Mean cord bilirubin level was 2.01 mg/dl. Mean total bilirubin on 48-hour post- natal day was 10.06 mg/dl. There was a positive correlation between cord bilirubin and 48-hour postnatal day serum bilirubin. The correlation between cord bilirubin and development of significant jaundice in the first three days is statistically significant.

Conclusions: Using cord bilirubin level of ≥ 3 mg/dl, hyperbilirubinemia can be predicted with sensitivity of 100%, specificity of 99%, positive predictive value of 66% and negative predictive value of 100%.

Keywords: Jaundice, term newborns, serum bilirubin.

References

  1. Stoll BJ, Kliegman RM. Jaundice and hyperbilirubinemia in the Newborn, In: Behrman RE, Kliegman RM, Jenson HB, (eds.) Nelson Textbook of Pediatrics. 17th ed. Philadelphia: WB Saunders Co; 2004. p. 592-6.
  2. Johnson L, Bhutani VK. Guidelines for the management of jaundice in the term and near-term infant. ClinPerinatol [serial online] 1998;25:555-74. Available from URL: http://europepmc.org/abstract/med/9779334. Accessed July 6, 2015.
  3. Bernaldo AJ, Segre CA. Bilirubin dosage in cord blood: could it prevent neonatal hyperbilirubinemia. Sao Paulo Med J 2004;122(3):99-103.
  4. Brown AK, Johnson L. The Year Book of Neonatal and Perinatal Medicine. Philadelphia, PA: Mosby Yearbook; 1996.
  5. Johnson L. Hyperbilirubinemia in the term infant: when to worry, when to treat. New York State J Med [serial online] 1991;91(11):483-9. Available from URL: http://psycnet.apa.org/record/1992-14094-001. Accessed July 8, 2015.
  6. MacDonald MG. Hidden risks: early discharge and bilirubin toxicity due to glucose-6-phosphate dehydrogenase deficiency. AAP [serial online]1995;96: 734-8. Available from URL: http://pediatrics.aappublications.org/content/96/4/739. Accessed July 16, 2015.
  7. Maisels MJ, Newman TB. Kernicterus in otherwise healthy, breastfed term newborns. AAP [serial online] 1995;96:730-3. Available from URL: http://pediatrics.aappublications.org/content/96/4/730.short. Accessed July 20, 2015.
  8. Penn AA, Enzmann DR, Hahn JS. Kernicterus in a full term infant. AAP [serial online] 1993;93:1003-6. Available from URL: http://pediatrics.aappublications.org/content/93/6/1003.short. Accessed July 22, 2015.
  9. Sola A. Changes in clinical practice and bilirubin encephalopathy in healthy term newborns. Pediatr Res 1995;37:145.
  10. Maisles MJ, Newman TB. Jaundice in full term and near term babies who leave the hospital within 36 hours: the pediatrician‟s nemesis. Clin Perinatol [serial online] 1998;25:295-302. Available from URL: http://europepmc.org/abstract/med/9646994. Accessed August 6, 2015.
  11. Centre for Clinical Research and Biostatistics (CCRB). Chinese University of Hongkong. Sample size calculator. Available at URL: https://www2.ccrb.cuhk.edu.hk/web/. Accessed August 12, 2015.
  12. Taksande A, Vilhekar K, Jain M, Zade P, Atkari S, Verkey S. Prediction of the development of neonatal hyperbilirubinemia by increased umbilical cord bilirubin. CurrPediatr Res 2005;9(1):5-9.
  13. Lucey JF. The unsolved problem of kernicterus in the susceptible low birth weight infant. Am Acad Pediatrics [serial online] 1972;49:646-7. Available from URL: http://pediatrics.aappublications.org/content/49/5/646.short. Accessed July 6, 2015.
  14. Bhutani VK, Johnson L, Sivieri EM. Predictive ability of a predischarge hour - specific serum bilirubin for subsequent significant hyperbilirubinemia in healthy term and near term newborns. AAP [serial online] 1999;103:6-14. Available from URL: http://pediatrics.aappublications.org/content/103/1/6.short. Accessed August 30, 2015.

Corresponding Author

Namganglung Golmei

Assistant Professor, Department of Pediatrics, RIMS, Imphal