Study of Cord Blood Bilirubin Levels in a Tertiary Care Centre of Kumaun Region (Uttarakhand) India

Title: Study of Cord Blood Bilirubin Levels in a Tertiary Care Centre of Kumaun Region (Uttarakhand) India

Authors: Amit Kumar Singh, Govind Singh, Sandeep Gaur

DOI: http://dx.doi.org/10.18535/jmscr/v4i10.25

Abstract

Jaundice in newborn is a very common problem. Neonatal hyper bilirubinemia (NH) may lead to kernicterus in otherwise healthy newborns. This can be easily prevented if excessive hyper bilirubinemia for age is promptly identified and appropriately treated. Newborns can be screened for severity of bilirubinemia before hospital discharge which may help in early detection of the newborns at risk for excessive hyper bilirubinemia during the first week of life. To determine the level of cord blood bilirubin in all healthy term new borns and asses its usefulness in predicting neonatal jaundice. Neonatal jaundice (NNJ) is an interesting, complicated and controversial clinical problem. It is a cause of concern for the parents as well as pediatricians. The concept of prediction of jaundice offers an attractive option to pick up babies at risk of neonatal hyper bilirubinemia. Physical examination is not a reliable measure of serum bilirubin. Under these circumstances it would be desirable to be able to predict the risk of jaundice, in order to implement early treatment and thereby minimize the risk of bilirubin dependent brain damage. Neonatal Hyper bilirubinemia has been defined as the bilirubin levels > 12.9 mg/dl in term babies and 15 mg/dl in preterm babies. Neonatal jaundice is visible manifestation in skin and sclera of elevated serum concentrations of bilirubin and this usually occurs in neonates if serum bilirubin level is >5 mg/dl. Most adults are jaundiced when total serum bilirubin (TSB) levels exceed 2.0 mg/dL. Kernicterus and near miss kernicterus are neonatal conditions that are associated with irreversible or reversible brain injury respectively. Concerns regarding jaundice have increased after reports of bilirubin encephalopathy occurring in healthy term infants without hemolysis. This study was conducted in 80 term newborns, a tertiary care center, Department of Pediatrics, Government medical college & Hospital, Haldwani Uttarakhand from July 2013 –Feb 2014. Serum bilirubin estimation was done in the Biochemistry department, Center lab of Government medical college, Haldwani (Formerly STM Haldwani) Uttarakhand. Serum bilirubin estimation was done by Diazo method. All babies were classified into four groups depending on the UCS bilirubin levels <0.9 (group-I), 1.0-1.9 (group-II), 2.0-2.9 (group-III), >3 (group-IV). Serum bilirubin estimation was done after 72 hours of postnatal life. Babies were categorized according to the need for phototherapy. Statistical analyses of significance (chi-square) were applied and the predictive values (sensitivity, specificity, PPV, NPV) were calculated using the conventional formulae. Incidence of NNJ in our study is 14 %. Mean total bilirubin on third post natal day was 9.14 mg/dl. Using CBB level of ≥ 1.9 mg/dl as a cut-off, NNJ can be predicted with sensitivity of 92.8%, specificity of 83.7 %, and positive predictive value of 48.1 % and negative predictive value of 98.6 %. The Negative Predictive Value (98.6%) in the present study suggests that in healthy term babies (without RH and ABO incompatibility with Cord Blood Bilirubin ≤ 1.9 mg/dl ) cord serum bilirubin can help to identify those newborns who are unlikely to require further evaluation and intervention. These newborns can be discharged with assurance to parents. Babies with CBB level ≥ 1.9 mg/dl should be followed more frequently.

Keywords: Newborn, Neonate, Neonatal Jaundice, Cord blood bilirubin.

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Corresponding Author

Amit Kumar Singh

Assistant Professor, Department of Pediatrics,

Government Medical College & Hospital, Haldwani (Nainital) Uttarakhand

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