Risk Stratification of Term Neonates for Development of Significant Hyperbilirubinemia by Cord Serum Bilirubin and Albumin Ratio

Abstract

ABSTRACT Background: Neonatal hyperbilirubinemia is a common neonatal problem. Although benign in the majority of the cases, few neonates develop bilirubin-induced neurological dysfunction further progressing to kernicterus. Due to early hospital discharge of healthy-term neonates, there is need of a reliable tool for early prediction of significant hyperbilirubinemia in them. Aim: The aim of this study is to determine the utility of cord total serum bilirubin/albumin ratio as an early predictor of significant neonatal hyperbilirubinemia in healthy-term newborns. Settings and Design: This is a tertiary care hospital-based prospective cohort study. Subjects and Methods: The study was conducted on 100 sequentially born healthy-term neonates. Cord bilirubin/albumin ratio was calculated and neonates were divided into two groups on the basis of 50th percentile value. Serum bilirubin was also measured at 72 h of life in all neonates and value ≥17 mg/dl was taken as significant requiring intervention. Statistical Analysis Used: Continuous variables were summarized as mean and standard deviation while nominal/categorical variables as percentage. Association between total serum bilirubin at 72 h of life and cord bilirubin/albumin ratio was assessed using two-sample independent t-test and Pearson correlation coefficient formula. Cutoff value of the ratio was derived using receiver operating characteristics (ROC) curve analysis. Results: Statistically significant association was observed between cord bilirubin/albumin ratio with the development of neonatal hyperbilirubinemia. On ROC analysis, cutoff point to predict significant hyperbilirubinemia was found to be >0.66 (92.9% sensitivity, 60.5% specificity, and PPV 79.61%). Conclusions: Cord total serum bilirubin/albumin ratio is a good parameter to predict significant neonatal hyperbilirubinemia in healthy-term neonates.