TO STUDY CORD BLOOD BILIRUBIN, ALBUMIN AND BILIRUBIN ALBUMIN RATIO (BAR) IN PREDICTING HYPERBILIRUBINEMIA AMONG THE NEWBORNS IN TERTIARY CARE HOSPITAL

Madhulika C. and M. Mathivanan*

ABSTRACT

Background: Hyperbilirubinemia remains an important neonatal condition. Acute bilirubin encephalopathy, often known as kernicterus, is a serious bilirubin toxicity that causes severe morbidity and mortality. The aim of the study is to assess the value of cord blood bilirubin, albumin and bilirubin albumin ratio (BAR) in predicting hyperbilirubinemia. Methodology: This is a prospective cohort study conducted over a period of 18 months at Paediatric department of AVMC hospital among all the deliveries. All inborn born of ≥35weeks of pregnancy were included in the study. Newborn with conditions like direct hyperbilirubinemia, and significant congenital anomalies were excluded from this study. The cord blood and blood samples were collected and analysed for bilirubin, albumin and bilirubin-albumin ratio among them and compared between the samples in predicting the hyperbilirubinemia. Continuous variables were represented as Mean and Standard Deviation, categorical variables as Frequency and percentage, statistical analysis using ROC curve was used to determine the best cut off value in predicting hyperbilirubinemia. Result: Total of 250 newborns were included in the study who met the inclusion criteria. The newborns were assessed for the hyperbilirubinemia in them requiring the phototherapy. There was significantly higher mean of cord blood bilirubin total among the patients required phototherapy (2.50±0.88mg/dl) compared to patients without hyperbilirubinemia (1.98±0.56mg/dl), similarly the BAR was found to be significantly higher in the patients with hyperbilirubinemia requiring the phototherapy (0.58±0.17) compared to the newborn without requiring the phototherapy (0.56±0.23). On statistical correlation of the serum BAR, it was found to be strongly correlated with the cord blood bilirubin, cord blood albumin and with serum total bilirubin. On ROC analysis, the best cut off values of cord blood bilirubin was 1.65mg/dl with sensitivity of 91.43%, specificity of 60.56% cord blood albumin was 2.9g/dl with sensitivity of 100%, specificity of 63.75% and cord blood bilirubin-albumin ratio (BAR) was 0.455 with sensitivity of 88.57%, specificity of 62.22%. Conclusion: Umbilical cord bilirubin, albumin and BAR are effective tools in predicting the hyperbilirubinemia among the infants requiring the phototherapy which might decide the total hospital stay.

Keywords: Cord blood bilirubin, Bilirubin-Albumin ratio, Hyperbilirubinemia, Newborn, Phototherapy.