Cord Blood Bilirubin, Albumin, and Hemoglobin as Predictors of Significant Hyperbilirubinemia in ABO-Incompatible Newborns: A Prospective Study in a Tertiary Neonatal Center in India

Background and aim ABO incompatibility is a common cause of neonatal hyperbilirubinemia. Early identification of babies at risk of neonatal jaundice allows timely treatment and helps minimize the risk of kernicterus. Given the paucity of data on Indian neonates with ABO incompatibility, this study aimed to identify reliable cord blood predictors of early hyperbilirubinemia by evaluating umbilical cord bilirubin, albumin, and hemoglobin levels in ABO-incompatible newborns. Methods This study was conducted at a tertiary care hospital in India and included 210 babies with blood groups A+ve, B+ve, or AB+ve born to mothers with blood group O+ve. All included neonates had a gestational age >37 weeks and a birth weight between 2.5 and 4 kg. Cord blood bilirubin, albumin, hemoglobin, and blood grouping and typing were evaluated at birth. Newborns were monitored for jaundice until the fifth postnatal day and further assessed by measuring total, direct, and indirect bilirubin levels. Results Of the 210 babies studied, 156 (74.28%) developed jaundice requiring phototherapy, 19 (9%) developed jaundice but did not require phototherapy, and 35 (16.7%) did not develop jaundice. The mean cord bilirubin level (2.8 mg/dl) was higher, while mean cord albumin (2.64 g/dl) and hemoglobin (14.41 g/dl) levels were lower among newborns who developed jaundice requiring phototherapy compared with those who did not. Babies with cord bilirubin >2.3 mg/dl, cord hemoglobin <15 g/dl, and cord albumin ≤2.5 g/dl were more likely to develop significant hyperbilirubinemia associated with ABO incompatibility. Conclusions Umbilical cord blood levels of bilirubin, albumin, and hemoglobin demonstrated potential as early predictors of significant hyperbilirubinemia in ABO-incompatible term neonates. Incorporating cord blood screening into routine neonatal care could facilitate early identification and timely intervention, particularly in resource-limited settings. However, further validation is needed before clinical implementation.