Cord Blood Bilirubin Level As An Early predictor Of Neonatal Hyperbilirubinemia- A hospital based prospective study

Background: Neonatal hyperbilirubinemia is common, complicated and controversial clinical problem.The American Academy of Pediatrics (AAP) recommends a follow up visit after 2-3 days to detect significant jaundice for all newbornswho are discharged within 48 hours. The present study was carried to evaluate the cord blood bilirubin levels as an early predictor of neonatal hyperbilirubinemia. Methods: The study group consisted of 500 term AGA neonates and Apgar score ≥ 7.The total bilirubin ≥ 15 mg/dl was defined as significant hyperbilirubinemia. Umbilical cord serum bilirubin (UCSB) was estimated and followed up daily forevidence of neonatal hyperbilirubinemiaupto five postnatal days. Prevalence of hyperbilirubinemia was 14% in study population.In case of clinical jaundice presenting before five days serum bilirubin level was estimated the day of detection. Values of bilirubin on fifth day were related with that of cord blood bilirubin . Mother's and newborn's blood groups were carried out. Direct Coomb’s Test was done in presence of ABO incompatibility.Data were analyzed using, chi-square, and Receiver OperatingCharacteristics (ROC) curve. Results: Mean UCSB was 1.56±0.70 mg/dl.There was significant association between route of delivery, birth order and hyperbilirubinemia requiring phototherapy (p<0.005).Using UCSB level of 1.9 mg/dLhyperbilirubinemia could be predicted with sensitivity of 90% and specificity of 82.55% and positive predictive value of 45.65% and negative predictive value of 98.07%.There was no significant association found between the mother’s blood group and the increased risk of hyperbilirubinemia in neonates in this study. Conclusion: This study suggests that the measurement of UCSB is a useful tool for early prediction of the subsequent course of jaundice in healthy term newborns in Indian population. It may help to improve the management of newborns.