Umbilical Cord Bilirubin Research Articles

Predictability of Umbilical Cord Serum Bilirubin in Estimating the Risk of Hyperbilirubinemia in Term Neonates with ABO Incompatibility- A Prospective Cohort Study

Introduction: Neonatal hyperbilirubinemia is a significant cause of morbidity among term neonates. Delayed follow- up of newborns may lead to considerable morbidity and encephalopathy. High bilirubin levels may necessitate exchange transfusion, especially in infants with ABO or Rh blood incompatibility. Measurement of Umbilical Cord Bilirubin (UCB) is an easily available, inexpensive and non invasive method to predict the development of hyperbilirubinemia in newborns. Aim: To determine the predictive value of UCB in estimating the risk of subsequent hyperbilirubinemia in term neonates with ABO incompatibility and to establish a UCB cut-off associated with the risk of hyperbilirubinemia development. Materials and Methods: This prospective cohort study was conducted at the Punjab Institute of Medical Sciences (PIMS) in Jalandhar, Punjab, India, from June 2022 to March 2023. A total of 113 term babies born to O+ mothers were included in the study. At the time of delivery, cord blood was drawn from the placental side of the cord for blood group, Direct Coomb’s Test (DCT), and serum bilirubin analysis. Infants were followed-up every 12 hours while inpatient and every 48 hours after discharge until day 5 for assessment of clinical jaundice. Significant hyperbilirubinemia was managed with phototherapy according to American Academy of Paediatrics (AAP) guidelines. The data was collected and subjected to statistical analysis using IBM Statistical Package for Social Sciences (SPSS) 20.0 software, with a significance level set at p-value <0.05, utilising Receiver Operating Characteristic (ROC) curve analysis. Results: A total of 113 term neonates were enrolled in the study, of which 57 (50.4%) were females. The mean cord bilirubin level was 2.6±1.06 mg/dL. A total of 40 (35.3%) babies developed significant jaundice requiring phototherapy, with a mean highest bilirubin level of 15±3.2 mg/dL. Using a cord bilirubin level of ≥2.0 mg/dL, significant hyperbilirubinemia could be predicted with a sensitivity of 80%, specificity of 54%, positive predictive value of 57.97%, and negative predictive value of 75%. There was a positive correlation between cord bilirubin and postnatal serum bilirubin in the present study, as determined by ROC analysis {Area Under Curve (AUC) >0.5}. Conclusion: The present study concluded that UCB is an important predictor of significant hyperbilirubinemia occurrence in newborns with ABO incompatibility.

Umbilical Cord Bilirubin as a Predictor of Neonatal Jaundice in Babies with ABO Blood Group Incompatibility versus without Incompatibility

Introduction: Severe hyperbilirubinaemia cause long-term morbidity that can be prevented by early prediction of the development of significant jaundice by measuring Umbilical Cord Bilirubin (UCB). Aim: To measure the predictability of UCB as an early marker of development of significant hyperbilirubinaemia needing phototherapy. Materials and Methods: The study was a prospective observational study conducted at Vinayaka Mission Medical College, Karaikal, Pondicherry, India. A total of 50 babies born between February and August 2022 were included in the study. Bilirubin levels were obtained at birth by umbilical cord sampling and rechecked again at third or fourth day. Blood group incompatibility was defined as A or B blood group babies born to O group mothers. Phototherapy was started when the bilirubin levels were above or upto 2 mg/ dL below the cut-off for that patient as indicated by the curve for the risk group of the patient as per the American Academy of Paediatrics (AAP) guidelines. Phototherapy also was started if clinically indicated by visual assessment by Kramers rule. Results: Results were analysed by Receiver Operating Characteristics (ROC) curve analysis for measurement of sensitivity and specificity for predicting significant neonatal hyperbilirubinaemia. ROC curve anlaysis revealed that a cutoff of UCB of 1.95 mg/dL resulted in an accepatable sensitivity and specificity for predicting significant jaundice requiring phototherapy at 75% and 68% respectively. ROC curve analysis revealed that Area Under Curve (AUC) for UCB levels of all babies for predicting jaundice requiring treatment was 0.765, 95% CI 0.592 to 0.937. Separate ROC analysis showed that AUC for UCB for predicting phototherapy in babies with blood group incompatibility (AUC 0.80, 95% CI 0.418 to 1.00) was more significant than the AUC for babies without blood group incompatibility (AUC 0.490, 95% CI 0.29 to 0.69). Conclusion: UCB has high predictability for significant jaundice requiring phototherapy. The prediction is more when babies with blood group incompatibility is considered compared to babies without blood group incompatibility.

The predictive significance of umbilical cord bilirubin and bilirubin/albumin ratio for neonatal jaundice in healthy term newborns.

The aim of this study is to determine the value of the questions asked in routine follow-up, the cord blood bilirubin (CBB) and bilirubin/albumin (B/A) ratio in estimating the risk of developing hyperbilirubinemia. Term and healthy 217 newborns whose CBB and albumin could be obtained and whose needed to be measured bilirubin level at the 24thand 72nd hours of life were included. Nutrition, sex and nationality, consanguinity between parents, jaundice in the sibling (s), mother's medications were questioned. CBB and albumin, serum total bilirubin (STB), serum albumin and transcutaneous bilirubin (TcB) at the 24th and 72nd hours of life, were recorded. CBB and cord B/A ratio, STB and serum B/A ratio, and TcB at the 24th and 72nd hours were found to be higher in the babies who received the phototherapy (p < 0.001 for all). The moderate positive correlation (correlation coefficient 0.383) at the 24th hour and strong positive correlation (correlation coefficient 0.759) at the 72nd hour between STB and TcB measurements was detected. In estimating the need for phototherapy the sensitivity and specificity of CBB were 74.2% and 56.5%, the sensitivity and specifity of cord B/A was 74.2%, and 61.8%. The cut-off value of CBB in estimating the need for phototherapy is 1.8, and the cut-off value of the cord B/A ratio is 0.56. When the cut-off value is 1.8 for the CCB and the cord B/A ratio is 0.56, the positive predictive values are low, but the negative predictive values are significantly high (92.9% and 93.5%, respectively) in determining the need for phototherapy. CBB and B/A ratio are important in predicting the possibility of indirect hyperbilirubinemia (IHB) development. Babies should be followed closely in terms of IHB development when their CBB value is 1.8 mg/dL and above, and the cord blood B/A ratio is 0.56 and above.

Correlation of cord blood bilirubin and neonatal hyperbilirubinemia in the setting of ABO incompatibility

Background: Neonatal hyperbilirubinemia (NHB) is the most common clinical condition requiring evaluation and treatment in neonates. Umbilical cord bilirubin measurement is a cheap, readily available, non-invasive procedure which helps in predicting the developing of hyperbilirubinemia in newborns. The aim of the study was to determine the correlation between cord blood bilirubin and subsequent development of clinically significant NHB in ABO incompatibility at 24 hours of life.Methods: 120 healthy term inborn neonates with A, B or AB blood group born to healthy mothers with O blood group were enrolled in this prospective clinical study, during the study period of 12 months, from June 2020 till May 2021. Cord blood (2 ml) was collected from placental side of cord and blood group and total and direct serum bilirubin were estimated. Venous blood (2 ml) sample was collected from peripheral vein of the baby and total and direct serum bilirubin estimation was done at 24, 48 and 72 hours of life.Results: During the study period, incidence of significant hyperbilirubinemia at 24 hours of age was 21.6%. Using cord bilirubin level of ≥3.5 mg/dl, hyperbilirubinemia can be predicted with sensitivity of 38.4%, specificity of 90.4% and positive predictive value of 52.6% and negative predictive value of 84.1%. Cord bilirubin and 24 hours postnatal serum bilirubin showed a positive correlation in this study.Conclusions: From the results and observations of the present study, one can consider the umbilical cord blood to be an important predictor for the occurrence of significant hyperbilirubinemia in newborns subsequently.

Risk factors for early hyperbilirubinemia in neonates: A cross-sectional study

Background: Neonatal hyperbilirubinemia is a commonly encountered problem in the early neonatal period. Hence, this study was undertaken in babies with significant hyperbilirubinemia to find out the factors which had caused an early rise of bilirubin (≤48 h) in some neonates compared to those who develop hyperbilirubinemia by 72 h. Factors that can predict early hyperbilirubinemia will help in early intervention.Methodology: This cross-sectional study was conducted in the neonatal intensive care unit of a tertiary care center from March 2021 to January 2022 among 405 healthy term neonates with significant hyperbilirubinemia. Serum bilirubin values were routinely done at 72 h, and earlier at 48 h if clinical icterus was noted by Kramer's rule and divided into two groups – one with hyperbilirubinemia at 48 h and another with hyperbilirubinemia by 72 h. Statistical analysis was done to find out the factors which could predict early hyperbilirubinemia.Results: Of the 405 neonates with significant hyperbilirubinemia, 270 (66.6%) had early hyperbilirubinemia and 135 (33.3%) had hyperbilirubinemia by 72 h. There were no statistically significant differences between the two groups with respect to sex, birth weight, mode of delivery, and baby blood group. Forty-two (49.4%) neonates with umbilical cord bilirubin (UCB) <2 mg/dl, 113 (65.6%) with UCB 2–2.5 mg/dl, 75 (72.1%) with UCB 2.5–3 mg/dl, 34 (89.5%) with UCB 3–3.5 mg/dl, and 6 (100%) with UCB >3.5 mg/dl developed early hyperbilirubinemia. Sixty-four (79%) neonates with bilirubin–albumin ratio (BAR) ≥0.79 developed early hyperbilirubinemia compared to 206 (63.6%) neonates with BAR <0.79 who had early hyperbilirubinemia.Conclusions: The UCB and bilirubin–albumin ratio correlated well with the development of early hyperbilirubinemia. Hence, it was concluded that those babies with a high UCB >2.1 mg/dl and/or high BAR ≥0.79 should be screened early for the development of hyperbilirubinemia.

Icterícia neonatal: fatores associados à necessidade de fototerapia em alojamento conjunto

OBJECTIVE: To investigate the frequency of neonatal jaundice and use of phototherapy. To identify risk factors associated with phototherapy in rooming-in care (RC). METHODS: Retrospective study with newborns = 35 weeks in a Tertiary Hospital RC from October to December 2017. Newborns were divided into two groups: treated and untreated for jaundice. Included: inborn neonates without congenital anomalies. Newborns who were admitted in a neonatal ward were excluded. Maternal, gestational, neonatal clinical data and care practices were evaluated. Outcome: use of phototherapy. Associations between groups were assessed using the Students t-test for continuous variables and chi-square for categorical ones. Multiple logistic regression was used to identify independent risk factors associated with phototherapy. RESULTS: 376 newborns were included. 176 newborns (47%) were diagnosed with neonatal jaundice and 66 newborns (18%) were treated with phototherapy. Treated group had lower gestational age (38 x 39 weeks), higher level of bilirubin in umbilical cord blood (2 x 1.5mg/dL), greater weight loss (7 x 6%), more frequent ABO incompatibility (35 x 10%) and prolonged length of hospital stay (79 x 50 hours). Logistic regression identified as independent risk factors for phototherapy: gestational age (OR=6); umbilical cord bilirubin (OR=16); ABO incompatibility (OR=12) and weight loss (OR=1.24). CONCLUSION: Neonatal jaundice was frequent in RC and almost 20% of the newborns were treated with phototherapy. Weight loss was the only preventable risk factor for phototherapy and no protective factor was found.

Umbilical cord bilirubin level used as a predictor of significant hyperbilirubinemia in newborns: An observational study

Umbilical cord bilirubin level used as a predictor of significant hyperbilirubinemia in newborns: An observational study

Cord blood bilirubin and prediction of neonatal hyperbilirubinemia and perinatal infection in newborns at risk of hemolysis

ObjectiveTo assess the accuracy of umbilical cord bilirubin values to predict jaundice in the first 48h of life and neonatal infection. MethodNewborn infants treated at a regional well-baby nursery born at ≥36 weeks of gestation were included in this retrospective cohort study. All infants born in a 3-year period from mothers with O blood type and/or Rh-negative were included and had the umbilical cord bilirubin levels measured. Hyperbilirubinemia in the first 48h was defined as bilirubin levels above the phototherapy threshold. Neonatal infection was defined as any antibiotic treatment before discharge. ResultsA total of 1360 newborn infants were included. Two hundred and three (14.9%) newborn infants developed hyperbilirubinemia in the first 48h of life. Hyperbilirubinemic infants had smaller birth weight, higher levels of umbilical cord bilirubin, a higher rate of infection and were more often direct antiglobulin test positive. Umbilical cord bilirubin had a sensitivity of 76.85% and a specificity of 69.58% in detecting hyperbilirubinemia in the first 48h, with the cut-off value at 34μmol/L. The area under the receiver operating characteristic curve was 0.80 (95% CI: 0.78–0.82). Umbilical cord bilirubin had a sensitivity of 27.03% and specificity of 91.31% in detecting perinatal infection. The area under the receiver operating characteristic (ROC) curve was 0.59 (95% CI: 0.57–0.63). ConclusionsA positive correlation was found between umbilical cord bilirubin and hyperbilirubinemia in the first 48h of life. Umbilical cord bilirubin is a poor marker for predicting neonatal infection.

Predictive value of cord blood bilirubin in neonatal hyperbilirubinemia: A prospective study

Background: As there is a tendency for early discharge from a hospital, some babies may develop significant neonatal jaundice at home, which may go unrecognized and cause subclinical damage to the growing brain. If such babies could be identified early, their discharge can be postponed for timely and better management. Objectives: The objectives of the study were to evaluate the umbilical cord bilirubin (UCB) levels as a predictor for hyperbilirubinemia in full-term and near-term newborns up to the 3rd day of life. Materials and Methods: A prospective cohort study was carried out in a tertiary care hospital in South India. Data were collected from the enrolled cases by a pre-designed proforma. Statistical analysis was carried out with the help of statistical measures, such as percentages and proportions and the sensitivity, specificity, and negative and positive predictive values (NPV and PPV). Results: A total of 301 newborns were enrolled. A cutoff UCB 2 mg/dl had 94% sensitivity, 93% specificity, 61% PPV, and 99% NPV. A total of 61% of neonates who had UCB levels ?2 mg/dL required phototherapy by the 3rd day of life. However, 99% of neonates who had UCB &lt;2 mg/dL did not require phototherapy, and these infants with low risk of hyperbilirubinemia could be discharged early from the hospital. Conclusion: The cutoff value of 2 mg/dL of UCB with 94% sensitivity and 93% specificity canbe used as a predictor for developing subsequent hyperbilirubinemia.

Umbilical cord bilirubin level and pre-discharge hyperbilirubinemia risk

Objectives To assess whether arterial umbilical cord bilirubin (aUCB) level at delivery predicts predischarge neonatal hyperbilirubinemia, facilitating a safe discharge from the hospital. Methods Prospective analysis of hospital biochemistry records identified near term and term infants with recorded aUCB and predischarge, at 36 h of life, capillary heal bilirubin (cHB), to identify those with a cutoff of bilirubin levels >9 mg/ml, >75th percentile on the nomogram of Bhutani et al. Results Of 616 study neonates, median (IQR) aUCB and cHB levels were 1.5 mg % (IQR 0.7–2.2) and 7.7 mg % (IQR 6.6–8.9), respectively. The values resulted statistically correlated (Pearson correlation coefficient 0.26, p < .0001) and an increment of 1 mg/dl in aUCB was associated with an increment (Regression coefficient, 95% confidence interval) of mean cHB 0.49 (0.33–0.65, p < .0001). Among these, 143 (23.2%) neonates developed bilirubin levels >9 mg/ml at 36 h of life and multivariable analysis confirmed that cHB levels (OR 1.49, 95% CI 1.22–1.82; p < .0001) and vaginal delivery (OR 2.34, 95% CI 1.33–4.36; p = .005) were significantly associated with bilirubin levels >9 mg/ml. Conclusions These data suggest that aUCB should be added to the list of major risk factors for neonatal hyperbilirubinemia.

Umbilical cord bilirubin as a predictor of neonatal jaundice: a retrospective cohort study

BackgroundHyperbilirubinaemia is a major cause of neonatal morbidity. Early identification of those infants most at risk might allow the development of targeted primary preventative therapy and follow-up. The objective of this study was to assess whether arterial umbilical cord bilirubin (aUCB) level at delivery predicts the development of neonatal jaundice in term deliveries.MethodsRetrospective analysis of hospital biochemistry records identified term deliveries with recorded aUCB. Infant medical records were reviewed to identify those who developed neonatal hyperbilirubinaemia (requiring treatment according to UK NICE guidelines) with/without a positive direct antiglobulin test (DAT).ResultsOf 1411 term deliveries with a clearly recorded aUCB, 30 infants developed clinically-significant jaundice (2.7%), of whom 8 were DAT + ve (0.6%) mostly due to ABO incompatibility. aUCB strongly predicted the development of DAT + ve jaundice (area under the ROC curve = 0.996), as well as all-cause jaundice (area under the ROC curve = 0.74). However, this effect was critically dependent on maternal blood group. Amongst infants at risk of ABO incompatibility (maternal blood groups O + ve/O-ve, 39.7%) the predictive value of aUCB for all cause jaundice was strengthened (area under the ROC curve = 0.88). Amongst those not at risk (defined maternal blood group not O + ve/O-ve, 51.0%) it disappeared completely (area under the ROC curve = 0.46). A cutoff of 35 μmol/l for mothers with blood group O + ve/O-ve increased the pre-test probability for all-cause jaundice of 4% to a post-test probability of 30%.ConclusionsFor infants of mothers with blood group O, aUCB predicts development of neonatal jaundice. There was no evident utility for infants of mothers with other blood groups. Estimation of aUCB should be considered as a strategy for early identification of those at risk of neonatal haemolytic jaundice.

Umbilical Cord Bilirubin Levels as a Predictor of Subsequent Development of Clinically Significant Neonatal Hyperbilirubinemia

Umbilical Cord Bilirubin Levels as a Predictor of Subsequent Development of Clinically Significant Neonatal Hyperbilirubinemia

Effectiveness of early clinical assessment and bilirubin estimation for prediction of neonatal hyperbilirubinemia

Background: Neonatal hyperbilirubinemia is common cause of neonatal morbidity seen in 60% term and 80% preterm neonate. Early clinical assessment and bilirubin estimation is important in preventing long term sequale of hyperbilirubinemia, preventable cause of neurological sequale (kernicterus). Methods: Clinical assessments of all Preterm and term neonate born in our medical college were studied for effectiveness of early clinical assessment (Kramer’s index) compared to it gold standard test serum bilirubin (TB). Results: A total of 500 neonates were studied in which 11.4 % developed significant hyperbilirubinemia. Cord blood bilirubin has a PPV-63.9% and specificity-99.1%. Kramer’s index is less effective clinically if serum bilirubin is in lower range, comparatively kramer’s index effectiveness increases as serum bilirubin increases with p value 0.001. Conclusions: 11.4% of neonates had significant hyperbilirubinemia requiring treatment. Umbilical cord bilirubin >3 mg/dl showed a good predictor for early detection of hyperbilirubinemia. Kramer’s index at 48 hours correlates significantly with higher levels of serum bilirubin with p value of 0.001.

Umbilical Cord Bilirubin Level as a Predictive Indicator of Neonatal Jaundice

BACKGROUND AND OBJECTIVE: Neonatal jaundice is a major problem among infants in the first weeks of life. Research on several indicators of severe neonatal jaundice including alpha-fetoprotein and umbilical cord bilirubin level has indicated contradictory results. Therefore, the aim of the present study was to evaluate the significance of umbilical cord bilirubin level as a predictive indicator of severe neonatal jaundice. METHODS: This prospective, cross-sectional study was performed on 102 healthy infants, born to healthy mothers at Babol Clinic Hospital, Babol, Iran. After birth, 2 cc blood samples were obtained from the umbilical cord and the bilirubin level was measured in the hospital laboratory. The infants were followed-up after hospital discharge in terms of jaundice presentations. In case jaundice was diagnosed in infants, they were compared in treated and untreated groups. FINDINGS: Clinical jaundice was not detected in 54 cases (52.94%). Overall, 48 neonates (47.05%) suffered from clinical jaundice and 10 cases (8.9%) presented with severe jaundice, requiring treatment based on the criteria proposed by the American Academy of Pediatrics (AAP). The mean umbilical cord bilirubin level was 1.82±0.42 mg/dl in the untreated group and 2.36±0.56 mg/dl in the treated group (P=0.000). The area under the ROC curve for umbilical cord bilirubin level was 0.722 in the treated group, based on the AAP criteria. The cut-off point of 2 mg/dl showed 80% sensitivity and 73% specificity in predicting severe jaundice (requiring treatment), based on the AAP criteria. CONCLUSION: As the results indicated, measurement of umbilical cord bilirubin level and determination of a suitable cut-off point could be valuable in predicting severe jaundice in newborns.

Umbilical Cord Blood Bilirubin Level Measurement in Predicting the Development of Significant Hyperbilirubinemia

Objectives: This prospective study was undertaken to identify the newborns at risk for developing significant hyperbilirubinemia using cord blood serum bilirubin levels. Methodology: This was prospective study with total of 282 healthy term newborns delivered at MNR Hospital, were included in study with birth weight more than 2,500 grams during one year period from March 2013 to March 2014. Soon after delivery cord blood was sent for serum bilirubin analysis. The data was analyzed using t-test, ROC curve and chi test and was considered statically significant, if value is P 0.05, while in cord bilirubin level there is highly significant difference P <0.05. In our study on the amount of umbilical cord bilirubin cut off point of 2 mg/dl had good sensitivity (94.12), specificity (90.9%), positive predictive value (69.57%) and negative predictive value (98.59%). Conclusion: The present study led to the conclusion that the bilirubin levels that were equal to or greater than 2 mg/100 ml umbilical cord blood can predict significant hyperbilirubinemia with high negative and positive predictive values and high levels of sensitivity and specificity.

Does umbilical cord bilirubin level have predictive value in pathologic neonatal hyperbilirubinemia

Introduction The increase in the use of breast feeding and the decrease in mothers' hospitalization in the past few years have caused an increase in the infant bilirubin level, so it is necessary to introduce methods which can identify infants with higher risks of hyperbiliru binemia. The aim of this study is to determine the predictive value of measuring the umbilical cord bilirubin for pathologic hyperbilirubinemia, that is the bilirubin more than 15mg /dl.Materials and Methods This prospective study was performed from November 2009 to December 2010 on the umbilical cord serum of 274 newborns who were born in Iran-Mashhad Razavi Hospital. The neonates’ Apgar scores were above 7, weights more than 2.5 kg and gestational ages above 37 weeks. Once again their bilirubin level was measured via skin during the third to fifth day. Using the Smirnov test, , one-sample Kolmogorov test, t-test, and Man Whitney test, we analyzed the data . P< 0.05 was considered significant.Results Out of 274 newborns, 178 cases were followed up. Ninety-three infants of the monitored cases had hyperbilirubinemia (total bilirubin ≥ 15 mg/dl or group A, 85 of the infants did not have pathologic hyperbilirubinmia (total bilirubin < 15 mg/dl or group B). The average umbilical cord bilirubin for group A was 2.32 ± 0.78 mg/dl, and for group B was 1.98 ± 0.72 mg/dl; so statistically, there is a significant difference. At the cut-off point of 2 mg/dl for umbilical cord bilirubin, sensitivity was obtained to be 68.86% and the specificity was obtained to be 61.18%.Conclusion If the amount of bilirubin in the umbilical cord is more than 2 mg/dl, it can be considered as a contributing factor among other risk factors in the prediction of the infant’s pathologic hyperbilirubinemia.

Predictive value of umbilical cord blood bilirubin in neonatal hyperbilirubinemia

IntroductionJaundice is a clinical condition that is often present in pediatric practice and constitutes one of the major issues within the neonatal period. It occurs in both the physiological and pathological processes in newborns.1 Although most newborns with jaundice are otherwise healthy, they need to be monitored because bilirubin is potentially toxic to the central nervous system.2 The American Academy of Pediatrics (AAP) in 2004 recommended that newborns discharged within 48h should have follow up visits after 2–3days to detect significant jaundice.3 Aim of the workThis study was done to evaluate the predictive value of umbilical cord bilirubin in identifying infants for subsequent hyperbilirubinemia, in full-term (FT) and late pre-term (PT) newborns. Subjects and methodsThis study is a prospective clinical study which was carried out on 94 newborns taken from the delivery room (DR) and neonatal intensive care unit (NICU) of Ismailia General Hospital at Ismailia Governorate. The study population was followed up clinically and by laboratory investigations from birth and daily during the first week of life. ResultsThe study population consisted of 50 males and 44 females with the mean gestational age of 38.70±1.38weeks in FT compared to 35.62±0.64 in late PT. It was shown that 40.4% of PT needed treatment in the form of phototherapy compared to 29.8% of FT, and no one of both groups needed exchange transfusion. The mean total cord bilirubin was higher among males, preterm, cesarean deliveries, and ABO and RH incompatibility positive newborns. It was found that when cord blood in late PT newborns was ⩾1.75mg/dl and ⩾1.85mg/dl in FT newborns, there was a probability that those newborns may need phototherapy and when the levels of total cord bilirubin were ⩾2.05mg/dl in PT newborns and ⩾2.15mg/dl in FT it means that those babies are in actual need of phototherapy. Thus the cut-off points for total cord bilirubin level in PT and FT groups were 2.05 and 2.15mg/dl respectively. ConclusionIt was concluded that total serum bilirubin in cord blood was indicative of the jaundice severity developed by healthy FT and late PT newborns without complications, during the first week of life. RecommendationsCord blood bilirubin could be a useful indicator of developing jaundice in newborns and the use of cut off cord bilirubin levels could be a useful predictor of significant hyperbilirubinemia.

Effect of oral zinc on hyperbilirubinemia in full term neonates

Background Oral zinc has been shown to reduce serum unconjugated bilirubin in animals, adolescents and low birth weight neonates. However, studies in healthy tenn neonates given oral zinc showed no reduction in hyperbilirubinemia based on time measurement in days. In order to improve accuracy, hyperbilirubinemia may be determined based on time measurements in hours.Objective To determine the effect of oral zinc on hyperbiliru-binemia in full term neonates, based on time measurement in hours, rather than days.Methods We conducted a randomized, double-blind clinical trial on healthy term neonates born spontaneously or through elective caesarean section in Hasan Sadikin Hospital from June to July 2010. Subjects were randomized into two groups: those receiving 5 mg of zinc sulphate and those receiving a placebo, sucrose, each twice daily. Serum total bilirubin level was examined at discharge and upon follow􀁂up at day 5 of life. Factors which may be related to hyperbilirubinemia such as maternal age, infants' gender, umbilical cord bilirubin levels and type of feeding, were analyzed by Chi-square test. Hyperbilirubinemia persistence and comparison of survival distributions were analyzed by Kaplan-Meier survival analysis and Logrank test.Results Out of 60 subjects, 26 had hyperbilirubinemia. The mean duration of hyperbilirubinemia in the 15 subjects in the zinc group and 11 in the placebo group were 116.5 hours and 117.3 hours, respectively. There was no significant difference in hyperbilirubinemia duration between the two groups ( P=0.496, 95% CI 111.5 to 122.7). In addition, Chi-square analysis of factors which may be related to hyperbilirubinemia showed no significant difference between the two groups (P &gt; 0.05).Conclusions Oral zinc 5 mg tMce daily made no significant difference in hyperbilirubinemia duration in full tenn neonates despite measuring in hours.

Prediction and non-invasive assessment of neonatal jaundice in the term healthy newborn infant.

The maternal and umbilical cord bilirubin concentration at delivery, a yellow skin colour on the first postnatal day, an increase in the yellow skin colour during the first 24 h or postnatal life, and carbon monoxide excretion are all associated with the later development of neonatal jaundice in the healthy, mature newborn infant. Based on the results from these methods, and especially when the results from two or more of the methods are combined, it is possible to define low- and high-risk groups as far as subsequent jaundice is concerned. If jaundice develops, yellow skin colour measurements can often replace plasma bilirubin determinations. Dependent upon the local current consensus for bilirubin determinations, around 50% of plasma bilirubin determinations can be avoided. Recent research suggests that yellow skin colour measurements may provide information concerning the risk of bilirubin encephalopathy, in addition to their relation to the plasma bilirubin concentration.

Maternal bilirubin, cord bilirubin, and placenta function at delivery and the development of jaundice in mature newborns.

The study material comprised 213 newborns with a birth weight above 2000 g, and their mothers. At delivery, blood samples were obtained from the umbilical cord and the mother's cubital vein for determination of the transplacental bilirubin gradient and assessment of placental function by means of the HPL concentration in the maternal blood. The HPL concentration showed no relation to the transplacental bilirubin gradient or the umbilical cord bilirubin concentration. Therefore, to the extent that the HPL concentration reflects the rate constants for bilirubin transfer, an increased transplacental bilirubin gradient or an increased cord bilirubin concentration could not be explained by an impaired ability of the placenta to transfer bilirubin. When the infants who became jaundiced were compared with the non-jaundiced, significantly higher transplacental bilirubin gradient (p less than 0.00001), cord bilirubin (p less than 0.00001) and maternal bilirubin values at the time of delivery (p less than 0.03) were found among the jaundiced infants. On the basis of the results it was possible to define subgroups of infants with significantly higher/lower risk of subsequent jaundice.