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Umbilical cord bilirubin as a predictor of neonatal jaundice: a retrospective cohort study
Kelsey D J Jones1,2, S E Grossman3, Dharshini Kumaranayakam3
1Neonatal Unit, Homerton University Hospital NHS Foundation Trust, London, UK.
Insights
Arterial umbilical cord bilirubin (aUCB) effectively predicts neonatal jaundice in infants born to mothers with blood group O. This measurement is valuable for identifying high-risk newborns for early intervention, particularly for haemolytic jaundice.
Area of Science:
- Neonatal Medicine
- Clinical Chemistry
- Perinatal Health
Background:
- Neonatal hyperbilirubinaemia is a significant cause of infant illness.
- Early identification of at-risk infants can guide preventative therapies.
- Predictive markers for neonatal jaundice are crucial for timely intervention.
Purpose of the Study:
- To evaluate arterial umbilical cord bilirubin (aUCB) as a predictor of neonatal jaundice in term deliveries.
- To assess the influence of maternal blood group on the predictive accuracy of aUCB.
- To determine the utility of aUCB for identifying infants requiring treatment for jaundice.
Main Methods:
- Retrospective analysis of hospital biochemistry and medical records.
- Inclusion of term deliveries with recorded aUCB levels.
- Identification of infants with clinically significant jaundice and positive direct antiglobulin test (DAT).
Main Results:
- aUCB strongly predicted DAT-positive jaundice (AUC=0.996) and all-cause jaundice (AUC=0.74).
- Predictive value was significant for infants of mothers with blood group O (AUC=0.88) but absent for others (AUC=0.46).
- A 35 μmol/l aUCB cutoff for blood group O mothers increased jaundice probability from 4% to 30%.
Conclusions:
- aUCB is a valuable predictor of neonatal jaundice for infants of mothers with blood group O.
- aUCB estimation aids in early identification of infants at risk for haemolytic jaundice.
- The predictive utility of aUCB is dependent on maternal blood group, specifically for ABO incompatibility.
Background:
Hyperbilirubinaemia is a major cause of neonatal morbidity. Early identification of those infants most at risk might allow the development of targeted primary preventative therapy and follow-up. The objective of this study was to assess whether arterial umbilical cord bilirubin (aUCB) level at delivery predicts the development of neonatal jaundice in term deliveries.
Methods:
Retrospective analysis of hospital biochemistry records identified term deliveries with recorded aUCB. Infant medical records were reviewed to identify those who developed neonatal hyperbilirubinaemia (requiring treatment according to UK NICE guidelines) with/without a positive direct antiglobulin test (DAT).
Results:
Of 1411 term deliveries with a clearly recorded aUCB, 30 infants developed clinically-significant jaundice (2.7%), of whom 8 were DAT + ve (0.6%) mostly due to ABO incompatibility. aUCB strongly predicted the development of DAT + ve jaundice (area under the ROC curve = 0.996), as well as all-cause jaundice (area under the ROC curve = 0.74). However, this effect was critically dependent on maternal blood group. Amongst infants at risk of ABO incompatibility (maternal blood groups O + ve/O-ve, 39.7%) the predictive value of aUCB for all cause jaundice was strengthened (area under the ROC curve = 0.88). Amongst those not at risk (defined maternal blood group not O + ve/O-ve, 51.0%) it disappeared completely (area under the ROC curve = 0.46). A cutoff of 35 μmol/l for mothers with blood group O + ve/O-ve increased the pre-test probability for all-cause jaundice of 4% to a post-test probability of 30%.
Conclusions:
For infants of mothers with blood group O, aUCB predicts development of neonatal jaundice. There was no evident utility for infants of mothers with other blood groups. Estimation of aUCB should be considered as a strategy for early identification of those at risk of neonatal haemolytic jaundice.