Utility of cord blood bilirubin as a predictors of significant neonatal Hyperbilirubinemia in healthy term neonate

Rajkumar M. Meshram, Saira Merchant, Swapnil D. Bhongade, Sartajbegam N. Pathan


Background: Clinical jaundice is evident in more than two-third neonates in their early neonatal life. Early identification of neonates at risk might allow early intervention and prevent complication. Objective of the study was to assess the cord blood bilirubin level as a tool to screen the risk of development of subsequent significant neonatal hyperbilirubinemia in term neonates.

Methods: A prospective observational study was conducted over a period of 2 years on 1040 healthy term neonates. Demographic profile, relevant maternal and neonatal information were recorded. Measurement of cord blood bilirubin, blood group/Rh typing and serum bilirubin at the end of 24 & 72 hours was done to predict significant hyperbilirubinemia.

Results: Incidence of significant hyperbilirubinemia was 11.53%. Gender, gestational age, mode of delivery and birth weight had no correlation with development of significant jaundice. 800 (76.93%) neonates had cord blood bilirubin level ≤3.0mg/dl and 240 (23.07%) neonate had cord blood bilirubin level >3.0mg/dl. Out of 240 (23.07%) neonates with higher cord bilirubin (>3.0 mg/dl), 108 (45%) had significant hyperbilirubinemia at the end of 24 hours with sensitivity 90.00%, specificity 85.65%, positive predictive value 45.00% and negative predictive value 98.50% while 110 (45.83%) neonates were observed with serum bilirubin >17mg/dl at the end of 72 hours with cord blood bilirubin >3mg/dl with sensitivity 91.67%, specificity 84.52% positive predictive value 45.83% and negative predictive value-98.61% and this difference was statistically significant.

Conclusions: Neonates with cord blood bilirubin level ≤3mg/dl can be safely discharged early whereas neonates with bilirubin >3mg/dl will need close follow up to check for development of subsequent significant jaundice. Hence cord blood bilirubin levels help to determine and predict the possibility of significant jaundice among healthy term neonates.


Cord blood bilirubin, Icterus, Jaundice, Significant hyperbilirubinemia

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