Umbilical cord albumin and serum bilirubin as predictive factors for hyperbilirubinemia in term neonates

Manu Shekhar, Vinod Kumar, Santosh Bhalke, Atul Goel


Background: Hyperbilirubinemia is one of the common causes of neonatal admission. As clinical evaluation may cause a delay in identification and subsequent initiation of medical therapy, there is a need for the sensitive and inexpensive predictive marker for hyperbilirubinemia in neonates. Measurement of cord albumin and its correlation with the serum bilirubin is one of the noninvasive predictive markers for Hyperbilirubinemia. The present study carried out to know the significance of umbilical cord albumin level as a predictor of neonatal hyperbilirubinemia.

Methods: It is a hospital-based prospective cohort study, total 100 healthy term new-borns admitted in the Neonatal Intensive Care Unit, were included in the study as per study protocol over a period of one year. The blood sample was collected from umbilical cord blood for the analysis of bilirubin and albumin, and post 72 hours of life venous blood obtained for estimation of serum bilirubin and albumin along with direct and indirect Coombs test.

Results: In this study most of the patients were in the gestational age of 37-38 weeks (71%) followed by 38-40 weeks (27%) and only 1% are >40 weeks. A positive correlation was observed between cord blood bilirubin, serum bilirubin, serum albumin, and cord blood albumin levels. Cord blood albumin was a better marker for neonatal hyperbilirubinemia with a sensitivity of 83%, and a specificity of 48%; as compared to cord blood bilirubin with a sensitivity and specificity of 73% and 39% respectively.

Conclusions: From this study, cord blood albumin level was demonstrated as a good predictive marker for neonatal hyperbilirubinemia with a sensitivity of 83.1%. and specificity 48.8%. Hence, cord blood albumin may be used as a non-invasive predictor for neonatal hyperbilirubinemia.


Albumin, Bilirubin, Cord blood, Neonatal hyperbilirubinemia

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Burke BL, Robbins JM, Mac Bird T, Hobbs CA, Nesmith C, Tilford JM. Trends in hospitalizations for neonatal jaundice and kernicterus in the United States, 1988-2005. Pediatr. 2009;123(2):524-32.

Chou SC, Palmer RH, Ezhuthachan S, Newman C, Pradell-Boyd B, Maisels MJ,et al. Management of hyperbilirubinemia in newborns: measuring performance by using a benchmarking model. Pediatr. 2003;112(6):1264-73.

Young Infants Clinical Signs Study Group. Clinical signs that predict severe illness in children under age 2 months: a multicentre study. The Lancet. 2008;371(9607):135-42.

Maisels MJ, Bhutani VK, Bogen D, Newman TB, Stark AR, Watchko JF. Hyperbilirubinemia in the newborn infant≥ 35 weeks’ gestation: an update with clarifications. Pediatr. 2009;124(4):1193-8.

Madden JM, Soumerai SB, Lieu TA, Mandl KD, Zhang F, Ross-Degnan D. Length-of-stay policies and ascertainment of postdischarge problems in newborns. Pediatr. 2004;113(1):42-9.

Bandi C, Vanaki R, Badakali AV, Pol RR, Yelamali B. Predictive value of total serum bilirubin within 6 hour of birth for the development of hyperbilirubinemia after 72 hours of birth. Journal of clinical and diagnostic research: JCDR. 2016;10(9):SC01.

Ipek IO, Bozaykut A, Çağrıl SC, Sezer RG. Does cord blood bilirubin level help the physician in the decision of early postnatal discharge?. The J Maternal-Fetal Neonat Med. 2012;25(8):1375-8.

Sun G, Wang YL, Liang JF, Du LZ. Predictive value of umbilical cord blood bilirubin level for subsequent neonatal jaundice. Zhonghua er ke za zhi= Chinese J pediatr. 2007;45(11):848-52.

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

Amos RC, Jacob H, Leith W. Jaundice in newborn babies under 28 days: NICE guideline 2016 (CG98). Archives Dis Childhood-Edu Pract. 2017;102(4):207-9.

Trivedi D, Markande D.S, Vidya B.U, Bhat M, Hegde P.R. Cord Serum Bilirubin and Albumin In Neonatal Hyperbilirubinemia. Int. J. Int sci. Inn. Tech. 2013;2(2):39-42.

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

Maisels MJ, Kring E. Length of stay, jaundice, and hospital readmission. Pediatr. 1998;101(6):995-8.

Taksande A, Vilhekar K, Jain M, Zade P, Atkari S, Verkey S. Prediction of the development of neonatal hyperbilirubinemia by increased umbilical cord blood bilirubin. Ind Medica. 2005;9(1):5-9.

Knudsen A. Prediction of the development of neonatal jaundice by increased umbilical cord blood bilirubin. Acta Pædiatr. 1989;78(2):217-21.

Awasthi S, Rehman H. Early prediction of neonatal hyperbilirubinemia. The Ind J Pediatr. 1998;65(1):131-9.

Pahuja M, Dhawan S, Chaudhary SR. Correlation of cord blood bilirubin and neonatal hyperbilirubinemia in healthy newborns. Intern J Contemp Pediatr. 2016;3(3):926.

Nahar Z, Shahidullah M, Mannan A, Dey SK, Mitra U, Selimuzzaman SM. The value of umbilical cord blood bilirubin measurement in predicting the development of significant hyperbilirubinemia in healthy newborn. Bangladesh J Child Health. 2009;33(2):50-4.

Aiyappa GKC, Shriyan A, Raj B. Cord blood albumin as a predictor of neonatal hyperbilirubinemia in healthy neonates. Int J Contemp Pediatr. 2017;4:503-6.