USEFULNESS OF CORD BILIRUBIN AS A SCREENING TEST TO PREDICT NEWBORNS AT RISK OF HYPERBILIRUBINEMIA
Jaishree Vasudevan, Reddy GMM, S.Thayumanavan
Department of Community Medicine, Chettinad Hospital and Research Center, Chennai, India
Abstract

Aim: To assess the utility of cord bilirubin as a screening test to predict subsequent neonatal hyperbilirubinemia.

Study Setting and Design: Retrospective study in departments of Pediatrics & Obstetrics and Gynecology (OBG) of a tertiary care teaching hospital in Chennai.

Methods: A total of 1114 term and near term babies born between January 2008 and December 2009 were included in the study. Umbilical cord bilirubin levels were analyzed in all the children. Serum bilirubin was obtained from neonates who were clinically jaundiced on day three. Total bilirubin of 14mg% and above was defined as hyperbilirubinemia. Correlation of cord bilirubin and subsequent hyperbilirubinemia was analyzed.

Results: Out of 1114 study subjects, 12.6% developed hyperbilirubinemia. The cord bilirubin level of 1.5 mg/dl had much stronger and statistically significant association with neonatal hyperbilirubinemia compared to all other cut off levels (Odds ratio - 2.75, 95% CI 1.51 to 5.02, p-value-0.001). However when cord bilirubin level of 1.5 mg/dl was used as screening test, the area under Receiver operating characteristic (ROC) curve was 0.6, which is closer to the null value of 0.5 (95% Cl 0.55 to 0.66, p-value 0.001). The positive predictive value (PPV) ranged from 11% to 17% with different levels of cord bilirubin. The negative predictive value was 96% with cord bilirubin level above 1.5 mg/dl and consistently maintained above 90% with increasing levels of cord bilirubin up to 3mg/dl making it difficult to set a cut off value.

Conclusion: Utility of umbilical cord serum bilirubin levels as a screening test to predict subsequent neonatal hyperbilirubinemia was very poor.
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