Utility of Cord Blood Albumin as a Predictors of Significant Neonatal Hyperbilirubinemia in Healthy Term Neonate.

Utility of cord albumin to predict significant hyperbilirubinemia

Abstract

Background: Approximately 60% of term and 80% of preterm neonates develop jaundice in first week of life and significant neonatal hyperbilirubinemia occurs in 3-5% of healthy term neonates. Objective:  To assess the cord blood albumin level as a tool to screen the risk of development of subsequent significant neonatal hyperbilirubinemia in term neonate. Subjects and 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 albumin, blood group/Rh typing and serum bilirubin at the end of 24 & 72 hours was done to predict significant hyperbilirubinemia. Results: A total of 1040 healthy term neonates were enrolled with male to female ratio of 1.4:1. 120 neonates had developed significant hyperbilirubinemia and required phototherapy while 2 of them  did not respond to phototherapy and needed exchange transfusion. Out of 245(23.55%) neonates with low cord albumin level (<2.8gm/dl), 104(42.44%) neonates had significant hyperbilirubinemia at the end of 24 hours with sensitivity 86.67%, specificity 84.67%, positive predictive value 42.45% and negative predictive value 97.66%. While 105 (42.85%) neonates had significant jaundice at the end of 72 hours with cord blood albumin <2.8 gm/dl with sensitivity 87.50%, specificity 84.78% positive predictive value-42.86% and negative predictive value-98.11%. Conclusion: Neonates with cord blood albumin level more than 2.8gm/dl can be safely discharged early whereas neonates with albumin levels <2.8g/dl will need close follow up to check for development of significant jaundice. Hence cord blood albumin levels help to determine and predict the possibility of significant jaundice among healthy term neonates.