Comparative Evaluation of Neonatal Hyperbilirubinemia Predictors through Umbilical Blood Samples

Objective: To evaluate and compare the predictive ability of cord blood albumin (CBA), cord blood bilirubin (CBB), and the cord blood bilirubin to cord blood albumin ratio (CBB/CBA) in neonatal hyperbilirubinemia (NNH). Methods: In this observational prospective analytical study, ninety-six healthy newborns were included after screening for exclusion criteria. Three umbilical cord blood samples were taken with all aseptic precautions for CBA, CBB, and blood group estimation. CBB/CBA was calculated after report collection. A total serum bilirubin sample was sent at 72 hours of life. All the values were statistically analyzed for correlation and comparison in neonates who developed NNH above the recommended phototherapy threshold. Results: A total of 21 (21.9%) neonates developed NNH above the phototherapy threshold. In the receiver operating characteristic (ROC) curve, the cut-off values obtained for CBA and CBB was 3 g/dL and 2.25 mg/dL, respectively. The sensitivity, specificity, and NPV for CBA were 74.7%, 57.1% and 38.71%, while for CBB they were 95.2%, 56% and 97.67% respectively. The cut-off value for the CBB/CBA ratio obtained was 0.76, with 85.7% sensitivity, 74.7% specificity and a negative predictive value (NPV) of 94.2%. Conclusions: We recommend CBB/CBA and CBB combined over CBA as it makes the test both highly sensitive and specific. Neonates having a CBB/CBA value of 0.76 or above and a CBB value 2.25 g/dL or above must be followed closely.