PERFORMANCE OF CORD BLOOD ALBUMIN AT BIRTH FOR PREDICTION OF SIGNIFICANT NEONATAL HYPERBILIRUBINEMIA

*Dr. Zahoor Hussain Daraz, Dr. Berkheez Shabir and Dr. Rehana Afshan

ABSTRACT

TITLE “Performance of Cord Blood Albumin at Birth for Prediction of Significant Neonatal Hyperbilirubinemia”. Background: Neonatal Jaundice is one of the commonest problems that occur in a newborn and most of the times it is physiological. However, a few (5-6%) become deeply jaundiced requiring immediate intervention. The cause of this significant hyperbilirubinemia has been attributed to many factors including a low concentration of bilirubin binding ligand Albumin. Henceforth Albumin in a critical concentration is of considerable importance in development of hyperbilirubinemia. Moreover, American Academy of Pediatrics recommends that newborn discharged within 48 hours should have a follow-up visit after 72 hours for any significant jaundice. The present study was therefore conducted to find out the cut off value of cord blood albumin at birth that can predict significant Neonatal Hyperbilirubinemia. Objective: To evaluate the performance of cord blood albumin at birth for prediction of significant Neonatal Hyperbilirubinemia with respect to sensitivity and specificity through receiver operator curve (ROC). Method: This prospective observational study was performed on 70 healthy term neonates. Relevant maternal history was taken. Neonates with low birth weight, perinatal asphyxia or septicemia were excluded. Cord blood was collected at birth and Cord Serum Albumin level (CSA) was measured. Study subjects were divided into 2 groups based on Cord Serum Albumin level. Neonates were assessed clinically every day. Total Serum Bilirubin (TSB) was measured during 72-96 hours of life. Total Serum Bilirubin (TSB) value ≥17mg/dl is considered significant Neonatal Hyperbilirubinemia (NH) requiring intervention like phototherapy (PT) or Exchange transfusion (ExT). Breast feeding was ensured and dehydration was excluded in each neonate. Result: Study population was divided into 02 groups based on Cord Serum Albumin (CSA) level at birth. Cord Serum Albumin level varied between 2.4g/dl to 4.5 g/dl. Mean Cord Serum Albumin level in Group-I was 2.58±0.12 and of group-II was 3.30±0.30 g/dl respectively and the difference among the 2 groups was significant; however, there was no significant difference between mean gestational age and mean birth weight of the 02 groups. (39.15weeks ±1.28 vs 39.09weeks ±0.15; 2877.6grams ±184.5 vs. 2850.5grams ±215.4. There was significant negative correlation seen between Cord Serum Albumin and Neonatal Hyperbilirubinemia (NH). Receiver operator curve (ROC) analysis was done and a cutoff point of 2.7 g/dL was determined with a sensitivity of 81.81%, specificity 96.6% for prediction of significant Neonatal Hyperbilirubinemia. Conclusion: Cord blood Albumin concentration at birth is a good predictor for significant hyperbilirubinemia and Cord Blood Albumin level of ≤2.7 g/dL has sensitivity of 81.81% and specificity of 96.5% in predicting Significant Neonatal Hyperbilirubinemia.

Keywords: CSA, TSB.