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

Sharanabasappa S. Dhanwadkar, Christo S. Rasalam, Zakaulla Masood


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.


Neonatal hyperbilirubinemia, Total bilirubin, Direct bilirubin, PPV

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