DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20190709

Prediction of significant hyperbilirubinemia by estimating cord blood bilirubin in neonates with ABO incompatibility

Ruchika Singh, Hemant Jain

Abstract


Background: Neonatal hyperbilirubinemia is a common condition that may occur in 60-70 % of term babies and the most common pathological cause leading to hyperbilirubinemia is ABO incompatibility. ABO incompatible newborns are reported to be at greater risk of significant hyperbilirubinemia and are associated with significant morbidity like development of kernicterus.  So early intervention, at proper time, is mandatory to prevent this sequel.

Methods: A prospective study included 240 term new-borns with gestational age of >37 weeks and birth weight >2.5 kg born to ‘O’ blood group mothers. Soon after delivery, cord blood was sent for blood group, total bilirubin and direct coombs test. All enrolled new-borns were assessed clinically daily till day 5th for appearance of hyperbilirubinemia using Kramer method. The data was analysed using descriptive analysis, ROC curve in SPSS version 14.

Results: Among two hundred forty ABO incompatible newborns, 40 (17%) had developed hyperbilirubinemia and among them most common blood group associated was B+ve (75%). Association between cord bilirubin content and maximum serum bilirubin content among newborn who developed hyperbilirubinemia was found to be significant (P value <0.01). As per ROC curve analysis, cord blood total bilirubin cut off value of 1.79mg/dl had sensitivity (82.5%), specificity (55.5 %), PPV (27.04%) and NPV (94.06).

Conclusions: Cord blood total bilirubin levels ≥1.79mg/dl has a good predictive ability for prediction of significant hyperbilirubinemia among ABO incompatible new-born. DCT is neither specific nor sensitive screening tool for development of Neonatal hyperbilirubinemia in ABO incompatibility.


Keywords


Cord blood, Hyperbilirubinemia, Neonatal

Full Text:

PDF

References


Kliegman RM, Behrman RE, et al. Nelson textbook of Paediatrics: 20th ed. New Delhi. Elseviers.2015;102:871-872.

Gholitabar M, McGuire H, Rennie J, Manning D, Lai R. Clofibrate in combination with phototherapy for unconjugated neonatal hyperbilirubinaemia. Cochrane Database Systematic Reviews. 2012(12).

American Academy of Pediatrics Subcommittee on Hyperbilirubinemia. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatr. 2004;114(1):297.

Narang A, Gathwala G, Kumar P. Neonatal Jaundice: An analysis of 551 cases. Indian Pediatr. 1997;34:429-32.

National Association of Neonatal N. Prevention of acute bilirubin encephalopathy and kernicterus in newborns. Position Statement 3049. NANN Board of Directors. Adv Neonatal care.2010;10(3):112-8.

Kalakheti BK, Singh R, Bhatta NK, Karki A, Baral N. Risk of neonatal hyperbilirubinemia in babies born to ‘O’positive mothers: A prospective cohort study. Kathmandu University Med J. 2009;7(1):11-5.

Behrman RE, Kliegman RM, Jensen HB, eds. N elson Textbook of Pediatrics. 17th ed. Philadelphia, WB saunders Co. 2004;596-605.

Mac Mahon JR, Stevenson D, et al. Management of neonatal hyperbilirubinemia. Avery's diseases of the newborn, 7th edition. Philadelphia. Pa. W. B. Saunders.1998;44.

Rosenfield, RE. A-B hemolytic disease of the newborn. Analysis of 1480 cord blood specimens, with special reference to the direct antiglobulin test and to the group 0 mother. Blood.1955;10:17-28.

Bhutani VK, Johnson L, Sivieri EM. Predictive ability of a predischarge hour-specific serum bilirubin for subsequent significant hyperbilirubinemia in healthy term and near-term newborns. Pediatr. 1999;103(1):6-14.

Agarwal R, Kaushal M, Aggarwal R, Paul VK, Deorari AK. Early neonatal hyperbilirubinemia using first day serum bilirubin level. Indian Pediatr. 2002;39(8):724-30.

Kramer LI. Advancement of dermal icterus in the jaundiced newborn. Amer J Dis Child.1969;118:454-8.

Doumas BT, Perry BW, Jendrzejczak B, Katona V. Pitfalls in the American Monitor kit methods for determination of total and “direct” bilirubin. Clin Chem. 1985;31:1779-89.

Heier HE, Fugelseth D, Lindemann R, Qvigstad E. Maternal blood group 0 as a risk factor of neonatal hyperbilirubinemia requiring treatment. J Norwegian Med Assoc: J Practical Med New Series. 1996;116(1):34-6.

Nair RR, Murty JS, Rao MN, Seetha T. ABO incompatibility and neonatal jaundice. Indian J Med Res. 1980;71:567.

Arif K, Bhutta ZA. Risk factors and spectrum of neonatal jaundice in a birth cohort in Karachi. Indian pediatr. 1999;36(5):487.

Bernaldo AJ, Segre CA. Bilirubin dosage in cord blood: could it predict neonatal hyperbilirubinemia?. Sao Paulo Med J. 2004;122(3):99-103.

Dufour DR, Monoghan WP. ABO hemolytic disease of the newborn: a retrospective analysis of 254 cases. Am J Clinical Pathol. 1980;73(3):369-73.

Murray NA, Roberts IA. Haemolytic disease of the newborn. Arch Dis Child Fetal Neonatal Ed.2007;92:F83-88.

Ahire N, Sonawane R, Gaikwad R, Patil S, Sonawane T. Study of correlation of cord blood bilirubin with neonatal hyperbilirubinemia. MVP J Med Sci. 2016;3(1):60-6.

Singhal PK, Singh M, Paul VK, Deorari AK, Ghorpade MG. Spectrum of neonatal hyperbilirubinemia: an analysis of 454 cases. Indian Pediatr. 1992;29(3):319-25.

Boskabadi H, Navaei M. Relationship between delivery type and jaundice severity among new-borns referred to Ghaem Hospital within a 6-year period in Mashhad. Iran J Obstet Gynecol Infertil. 2011;14(4):15-21.

Tamook A, Salehzadeh F, Aminisani N. Etiology of neonatal hyperbilirubinemia at Ardabil Sabalan hospital, 2003. J Ardabil Univ Med Sci.2005; 5(4):316-20.

Chang PF, Lin YC, Liu K, Yeh SJ, Ni YH. Risk of hyperbilirubinemia in breast-fed infants. J Pediatr. 2011;159(4):561-5.

Banasia RP, Jain H. Prediction of significant hyperbilirubinemia in term new-borns using cord blood bilirubin. Int J Current Res Review.2015;7(15):36.

Satrya R, Effendi SH, Gumida DA. Correlation between cord blood bilirubin level and incidence of hyperbilirubinemia in term newborns. Paediatr Indonesiana. 2009;49(6):349-54.

Knupfer M, Pulzer F, Gebauer C, Robel-Tillig E, Vogtmann C. Predictive value of umbilical cord blood bilirubin for postnatal hyperbilirubinaemia. Acta Paediatr. 2005; 94(5):581-7.

Risemberg HM, Mazzi E, MacDonald MG, Peralta M, Heldrich FR. Correlation of cord bilirubin levels with hyperbilirubinaemia in ABO incompatibility. Arch Dis Childhood. 1977;52(3):219-22.

Ashish Pradhan, Rachna Lamichaney, Vibhu Sharma. Cord blood bilirubin level as a predictor of development of pathological hyperbilirubinemia in new-borns. Int J Contemp Pediatr. 2017;4(4):1519-24.

Satrya R, Effendi SH, Gumida DA. Correlation between cord blood bilirubin level and incidence of hyperbilirubinemia in term newborns. Paediatr Indonesiana. 2009;49(6):349-54.

Taks A, Vilhekar K, Jain M, Zade P, Atkari S, Verkey S. Prediction of the development of neonatal hyperbilirubinemia by increased umbilical cord blood bilirubin. Current Pediatr Res. 2005;9(1).