Comparison of cord bilirubin and bilirubin albumin ratio to predict significant hyperbilirubinemia in healthy full-term neonates

Abstract

Background: Early prediction and identification of severe hyperbilirubinemia for that age and appropriate treatment are must to prevent kernicterus. Objective: The objective is to study the predictive value of bilirubin albumin ratio (BAR) and to compare it with cord bilirubin alone for early identification of significant neonatal hyperbilirubinemia in healthy term neonates. Materials and Methods: This prospective cross-sectional study was done in a tertiary care center located in Central India on 543 healthy term neonates. Cord blood of 2 ml was collected during the delivery from the placental end and sent for BAR and cord bilirubin analysis. All the neonates had undergone total serum bilirubin estimation and neonates with serum bilirubin ≥17 mg/dl at ≥72 h of age were defined to have significant hyperbilirubinemia. Results: Among the study population, 44 neonates developed significant hyperbilirubinemia. Sensitivity and specificity of cord BAR were 95.45% and 89.78%. Sensitivity and specificity of cord blood bilirubin were 95.65% and 95.57%. Positive predictive value (PPV) and negative predictive value (NPV) of cord BAR were 45.16% and 99.55%. PPV and NPV of cord blood bilirubin were 64.70% and 99.58%. Considering mean as the cutoff value, cutoff value for cord BAR was 0.89 and it was 2.95 for cord blood bilirubin. Diagnostic accuracy of cord BAR and cord blood bilirubin in predicting the hyperbilirubinemia was 90.79% and 96.31%, respectively. Conclusion: Both cord BAR and cord blood bilirubin are the early predictors of neonatal significant hyperbilirubinemia, but cord blood bilirubin is the better diagnostic tool than the former in early detection of neonatal jaundice.