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.

Cord Blood Bilirubin, Albumin and Bilirubin/Albumin Ratio versus Hydrogen Peroxide as Early Predictors of Significant Neonatal Hyperbilirubinemia

“…This also comes in agreement with EL Mashad et al, [17] who found that bilirubin/albumin ratio is a useful predictor for occurrence of jaundice; a cutoff level of cord blood bilirubin/ albumin of 0.82 had 88.9% sensitivity, 85.7% specificity, PPV 94.1% and NPV of 75% and also comes in agreement with Bhat J. et al [20] who conducted their study on neonates with gestational age ≥ 35w and Ramteke S et al, [15] on healthy term neonates and found the same results. This can be explained as the bilirubin/albumin ratio B/A might provide a better estimate of free bilirubin because it contains 2 of the 3 factors determining free bilirubin (TSB, albumin and the albumin binding affinity) [21].…”

“…Concerning cord blood bilirubin; our data showed that there was positive significant correlation between the cord blood bilirubin levels and the incidence of significant indirect hyperbilirubinemia on the 3 rd day in the two studied groups (P value < 0.001) and also the duration of phototherapy in the two studied groups. This comes in agreement with Khairy et al [7] who conducted their study on full term neonates, Ramteke S et al [15] on healthy term neonates, Ipek et al [16] on full term neonates and EL Mashad et al, on 75 neonates with gestational age ≥ 35w and found a highly significant increase in the cord serum bilirubin levels in babies who developed significant neonatal hyperbilirubinemia [17].…”

“…However, Bhat J et al, [20] concluded that cord blood albumin has the best predictive value, followed by bilirubin/albumin ratio and cord blood bilirubin in predicting development of subsequent neonatal hyperbilirubinemia and this can be explained by different characteristics of the studied groups as they conducted their study on neonates with gestational age ≥ 35w and they also measured TSB on 5th day. Ramteke S et al, [15] who conducted their study on term neonates only; found that both, the cord bilirubin/albumin ratio and bilirubin, are early predictors of significant neonatal hyperbilirubinemia; however, cord blood bilirubin was found to be a better tool.…”

“…However, higher cut-off values ranging between 2 and 2.7 mg/dl were found in other studies. This may be owing to the characteristics of the different studied groups, where the cases were all full-term infants (Ramteke S et al [15] Ipek et al [16]).…”

Cord blood bilirubin, albumin, and bilirubin /albumin ratio for predicting subsequent neonatal hyperbilirubinemia

“…Similarly, a previous study reported a cord blood bilirubin/albumin ratio cut-off of 0.82, as obtained by ROC curve, and with 88.9% sensitivity, 85.7% specificity, PPV 94.1%, and NPV 75% for predicting neonatal hyperbilirubinemia in a high-risk group. 15 Ramteke et al 21 derived a 0.89 cut-off point of cord bilirubin/albumin ratio, and suggested that 95.5% of patients will likely develop future neonatal NNH if their ratio is above 0.89.…”