Cord blood bilirubin level as a predictor of development of pathological hyperbilirubinemia in new-borns


  • Ashish Pradhan Department of Pediatrics, Sikkim Manipal Institute of Medical Sciences, Gangtok, Sikkim, India
  • Rachna Lamichaney Department of Pathology, Sikkim Manipal Institute of Medical Sciences, Gangtok, Sikkim, India
  • Vibhu Sharma Department of Pediatrics, Sikkim Manipal Institute of Medical Sciences, Gangtok, Sikkim, India



Pathological hyperbilirubinemia, Cord blood bilirubin, New-borns, Prediction


Background: There may be a delay in recognition of pathological hyperbilirubinemia which may lead to serious consequences in the new born. The purpose of this study was to verify whether the cord bilirubin levels predicted the development of pathological hyperbilirubinemia.

Methods: In this hospital based prospective cross-sectional study conducted at Central Referral Hospital, Gangtok from December 2014 to November 2015, 202 live new born meeting the inclusion criteria were enrolled. After birth, cord blood was collected for the estimation of cord blood bilirubin and the babies were followed up daily for the development of clinical jaundice. Peripheral venous blood was collected for the estimation of serum bilirubin levels in those who developed clinical jaundice.

Results: The incidence of pathological hyperbilirubinemia in our study is 12.87%. The mean gestational age is 38.3 weeks. There is a significant association between cord blood total bilirubin levels and the development of pathological hyperbilirubinemia in newborns with a P-value of 0.000. A critical cord bilirubin level ≥ 2.50mg/dl has sensitivity of 84.1%, specificity of 88.5%, positive predictive value of 98% and negative predictive value of 45.1% for predicting the risk of developing pathological jaundice.

Conclusions: This study concludes that cord blood total bilirubin levels reliably predict the occurrence of pathological hyperbilirubinemia as defined by current operational guidelines. 


Gregory ML, Martin CR, Cloherty JP. Neonatal Hyperbilirubinemia In: Cloherty JP, Eichenwald EC, Hansen AR, StarkAR, eds. Manual of Neonatal Care. Lippincott William’s and Wilkins. 7th ed. Philadelphia;2012:304-9.

Namasivayam A, Waldemer CA. Jaundice and Hyperbilirubinemia in the Newborn In: Kliegman RM, Stanton BF, St. Geme JW, Schor NF, Behrman RE, eds. Nelson textbook of Pediatrics. 19th ed. Philadelphia, PA:Saunders;2011:871-80.

Penn AA, Enzmann DR, Hahn JS, Stevenson DK. Kernicterus in a full-term infant. Pediatrics. 1994;93(6):1003-6.

Maisels MJ, Newman TB. Kernicterus in otherwise healthy, breast-fed term newborns. Pediatrics. 1995;96(4):730-3.

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;9:5-9.

American Academy of Pediatrics Subcommittee on Hyperbilirubinemia. Management of Hyperbilirubinemia in the new born infant 35 weeks or more weeks of gestation. Pediatrics. 2004;114: 297-316.

Awasthi S, Rehman H. Early Prediction of Neonatal Hyperbilirubinemia. Indian J Pediatr. 1998;65:131-9.

Randew S, Grower N. Predicting Neonatal hyperbilirubinemia using first day serum bilirubin levels. Indian J Pediatr. 2010;77:147-50.

Dhanwadkar SS, Christo S. Rasalam, Masoodet Z. Effectiveness of early clinical assessment and bilirubin estimation for prediction of neonatal hyperbilirubinemia. International J. Contemporary Pediatrics. 2016;3:477-84.

Rostami N, Mehrabi Y. Identifying the newborns at risk for developing significant hyperbilirubinemia by measuring cord bilirubin levels. J Arab Neonat Forum. 2005;2:81-5.

Knudsen A. Prediction of the development of neonatal jaundice by increased umbilical cord blood bilirubin. Acta Pediatr Scand. 1989;78:217-21.

Satrya R, Hidayat S, Effendi, Gurnida DA. Correlation between cord blood bilirubin level and incidence of hyperbilirubinemia in term newborns. Paediatrica Indonesiana. 2009;49:349-54.

Risemberg HM, Mazzi E, Macdonald MG, Peralta M, Heldrich F. Correlation cord bilirubin levels with hyperbilirubinemia in ABO incompatibility. Arch Dis Child. 1977;57: 219-22.

Bernaldo A JN, Segre CAM. Bilirubin dosage in cord blood could it predict neonatal hyperbilirubinemia. Sao Paulo Med J. 2004;122:99-103.

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. Pediatrics. 1999;103:6-14.

Stevenson DK, Fanaroff AA, Maisels MJ, Young BW, Wong RJ, Vreman HJ, et al Prediction of hyperbilirubinemia in near-term and term infants. Pediatrics. 2001;108:31-9.

Trivedi DJ, Markande DM, Vidya BU, Bhat M, Hegde PR. Cord serum bilirubin and albumin in neonatal hyperbilirubinemia. Int J Integrative Sci Innovation Tech (IJIIT). 2013;1(2):39-42.

Rosenfeld J. Umbilical cord bilirubin levels as predict-or of subsequent hyperbilirubinemia. J Fam Pract. 1986;23:556-8.

Nahar Z, Shahidullah MD, 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.






Original Research Articles