Author(s): Amar Taksande, Krishna Vilhekar, Manish Jain, Preeti Zade, Suchita Atkari, Sherin Verkey
In this prospective study the predictive value of the development of hyperbilirubinemia by increased umbilical cord blood bilirubin has been evalated. The project was completed in Level II NICU, paediatric department, KHS hospital, Sewagram. A total of 200 healthy term neonates with gestation >37 weeks, in absence of significant illness or Rh hemolysis were included. Cord bilirubin was estimated by micromethod using calorimeterically using green filter with 540nm wavelength. Neonates were followed up clinically every 12 h till discharge and then after 72 h. total serum bilirubin(TSB) level was estimated again. All infants were exclusively breastfed. Mean cord bilirubin was 2.38±0.51. Clinically detectable jaundice was present in 112 (56%) and hyperbilirubinemia occurred in 19 (9.5%) infants. Peak serum bilirubin of these 19 babies, at 83.21±5.27 hours of age was 18.3±0.82mg/dl. A cord bilirubin < 2mg/dl was present in 156 infants and only 2 (1.28%) neonates developed hyperbilirubinemia subsequently. In the remaining 44 neonates, with cord bilirubin >2mg/dl, subsequent hyperbilirubinemia developed in 17 (38.63%) (sensitivity 89.5%, specificity 85.1%, positive predictive value 38.6% and negative predictive value 98.7%.). No newborns had a serum total bilirubin level of ≥217 mg/dL in the first 72 hours of life. A mean cord serum bilirubin level of ≥2 mg/dL had the highest sensitivity (89.5%). At this critical cord serum bilirubin value, the negative predictive value was very high (98.7%) and the positive predictive value was fairly low (38.6%). The use of the critical cord bilirubin level of 2 mg/dL in all healthy term newborn will pre-dict significant hyperbilirubinemia.