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


  • Sharanabasappa S. Dhanwadkar Department of Pediatrics, DM Wayanad Institute of Medical Science, Wayanad, India
  • Christo S. Rasalam Department of Pediatrics, Dr. SM CSI Medical College, Trivandrum, India
  • Zakaulla Masood Department of Pediatrics, DM Wayanad Institute of Medical Science, Wayanad, India




Neonatal hyperbilirubinemia, Total bilirubin, Direct bilirubin, PPV


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.


Ambalavanan N, Waldemar A, Carlo. Jaundice and hyperbilirubinemia in the newborn. In: Nelson textbook of pediatrics. Kliegman R, Stanton B, Schor. 19th edition. Elsever company. 2011;96:603-7.

Madan A, James R, Macmohan. Neonatal hyperbiliruinemia. In: Avery’s textbook of new born. Gleason C, Ballard P, Taeusch. 8th edition. Elsevier Company. 79:1226-1230.

Curty EM, Bradley CF. A randomized controlled evaluation of early postpartum hospital discharge. 1990;17:199-204.

Maisels MJ, Kring E. Length of stay, jaundice and hospital readmission. Pediatrics. 1998;101:995-8.

Lee KS, Perlman M, Ballantyne M. Association between duration of neonatal hospital stay and readmission rate. J Pediatr. 1995;127:758-66.

American Academy of Pediatrics. Practice parameter: Management of hyperbilirubinemia in the healthy term newborn. Pediatrics. 1994;94:558-67.

Johnson L, Brown AK, Bhutani VK. BIND: A clinical score for bilirubin induced neurologic dysfunction in newborns. Pediatr Suppl. 1999;104:746.

Lucia M, Camila R, Gregory. Neonatal hyperbilirubinemia. In: Manual of Neonatal care. Cloherty J, Eichenwald E, Hansen A, et al. 7th Edition. Lippincott Williams and Wilkins. 2011;26:304-39.

Cherian G, Steven J, Soldin. Automated Jendrassik-Grof method for measurement of bilirubin in serum. Clinical chemistry 2002;27:748-52.

Maheshwari A, Waldemar A. Jaundice and hyperbilirubinemia in new born. In: Nelson Textbook of Pediatrics. Kliegman R, Stanton B, Schor NF et al 19th edn, Elsevier company. 2011:603-12.

Maisels MJ, Newman TB Kernicterus in otherwise healthy, breast-fed term new borns. Pediatrics 1995;96:730-3.

Agarwal R, Kaushal M, Aggarwal R. Early Neonatal Hyperbilirubinemia Using First Day Serum Bilirubin Level. Indian Pediatrics. 2002;39:724-30.

Alpay F, Sarici SU, Tosuncuk HD. The Value of First Day Bilirubin Measurement in Predicting the Development of Significant Hyperbilirubinemia in Healthy Term New borns. Paediatrics. 2000;106(2):16.

Newman TB, Klebanoff M. Neonatal hyperbilirubinemia and long-term outcome: Another look at the collaborative perinatal project. Pediatrics. 1993;92:651-7.

Carbonell EX, Botet MF, Fiqueras A. Hyperbilirubinemia in full-term newborns. Predictive factors. An Esp pediatr. 1999;504(4):389-92.






Original Research Articles