Cord Blood Bilirubin as a Predictor of Neonatal Hyperbilirubinemia
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- Category: Vol. 80, June 2012
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Cord Blood Bilirubin as a Predictor of Neonatal Hyperbilirubinemia,NAGWA HAMDI, ALI ELGAYAR and MOHAMMED HOSSAM SALAH
Abstract
Hospital readmission for neonatal hyperbilirubinemia is a cause of concern among clinicians in neonatal departments. While early Hospital discharge of neonates is currently rec-ommended by the neonatologists, it carries the risk of delayed recognition of hyperbilirubinemia and the possibility of brain damage due to kernicterus. In our study we aimed to study whether umbilical cord serum (UCS) bilirubin values could predict the risk of significant hyperbilirubinemia requiring treatment in newborns.
Patients and Methods: In a prospective study carried out at the Neonatal Department of Al-Galaa Teaching Hospital, umbilical cord serum (UCS) bilirubin was collected from 234 newborns who were categorized into three groups according to UCS bilirubin levels, <2mg/dl, 2-4mg/dl & >4mg/dl re-spectively. All demographic data was collected from all included newborns and compared among the three groups. Maternal and neonatal blood groups were checked as well cord hemoglobin and hematocrit concentration. The neonates were then followed by TcB at 24hrs, 48hrs & 72hrs of postnatal age and those who showed significant high TcB values ac-cording to the hour-specific nomogram, were then sampled by venous blood for total & indirect bilirubin levels. Significant hyperbilirubinemia was interpreted as the need for medical intervention in the form of phototherapy and/or exchange transfusion.
Results: A cut-off value of neonatal hyperbilirubinemia in cord blood was 2mg/dl and the end point of the study was the need for treatment. The mean value for total bilirubin in cord blood was significantly higher among newborns whose bilirubin values required phototherapy. The specificity reached 94.2% with a negative predictive value (NPV) of 96.32%. At cut-off cord serum bilirubin level >4mg/dl, the specificity was 98.92% and the NPV was 99.1%.
Conclusion: Cord blood serum bilirubin can be used as a useful screening test for predicting neonatal hyperbilirubine-mia and allowing safe postnatal Hospital discharge.