Cord Blood Bilirubin, Albumin and Bilirubin/Albumin Ratio versus Hydrogen Peroxide as Early Predictors of Significant Neonatal Hyperbilirubinemia

Abstract

Aims: To evaluate significance of cord blood bilirubin, albumin, bilirubin /albumin ratio and hydrogen peroxide as early predictors of significant neonatal hyperbilirubinemia. Place and Duration of Study: Egypt, Tanta University Hospital (at delivery room and follow up was done in Neonatal Intensive Care Unit (NICU) over one year from April 2019 to April 2020. Methodology: We included 80 neonates allocated into two groups (40 each), Group I included neonates with gestational age between 30 to less than 35 weeks, Group II neonates with gestational age ≥35 weeks. They were subjected to history taking, clinical assessment and lab investigations (cord blood albumin, bilirubin, hydrogen peroxide level and blood bilirubin/albumin ratio, 3rd day total and direct serum bilirubin level and others). Follow up done for developing jaundice on 3rd day. Results: There was statistically significant increase in the incidence of significant hyperbilirubinemia in group I (82.5%) in comparison with group II (27.5%) (P-value <0.001). There was positive significant correlation between cord blood bilirubin (P<0.001), bilirubin/albumin ratio (P <0.001) and hydrogen peroxide (P=0.012 in GI) (P = 0.001 in GII) and 3rd day TSB levels in the studied groups. There was negative significant correlation between cord blood albumin and 3rd day TSB levels in the studied groups (P < 0.001). There was positive significant correlation between cord blood bilirubin (P <0.001 in GI) (P =0.024 in GII), bilirubin/ albumin ratio (P <0.001 in GI) (P =0.002 in GII) and hydrogen peroxide (P <0.001) and the duration of phototherapy in the studied groups. There was negative significant correlation between cord blood albumin and the duration of phototherapy in group I (P =0.001), while there was no significant correlation between cord blood albumin and the duration of phototherapy in group II (P = 0.118). Conclusion: When comparing the four cord predictors for significant indirect hyperbilirubinemia; bilirubin/albumin ratio was the most accurate predictor with higher sensitivity and specificity, followed by cord blood bilirubin, then albumin, while hydrogen peroxide was the least accurate in all neonates ≥ 30 weeks.