1Department of Paediatrics, Sri Venkateshwaraa Medical College Hospital and Research Centre, Ariyur, Puducherry.
Background: One of the most common clinical conditions in newborns is neonatal hyperbilirubinemia, which can lead to severe illness and kernicterus if left untreated. It continues to be a significant contributor to NICU admissions in India, with geographical differences such as a greater incidence in Puducherry associated with risk factor prevalence and healthcare access. Serum total bilirubin, transcutaneous bilirubin, and risk factor assessment are among the methods used to forecast this condition, which is defined as serum bilirubin over the 95th percentile for age. Bilirubin and albumin in umbilical cord blood, as well as the bilirubin/albumin ratio, have become trustworthy indicators for early risk assessment. The identification of newborns at risk is further improved by developments in artificial intelligence and predictive modeling. This study evaluates the correlation between cord blood bilirubin and subsequent hyperbilirubinemia, aiming to inform uniform screening protocols and preventive strategies to improve neonatal outcomes.
Aim and Objectives: The objective of the study is to estimate the relationship between newborn umbilical cord blood bilirubin and occurrence of neonatal hyperbilirubinemia, to estimate the relationship between newborn umbilical cord blood albumin and occurrence of neonatal hyperbilirubinemia and to assess the ratio of newborn umbilical cord blood bilirubin/newborn umbilical cord blood albumin in prediction of Neonatal hyperbilirubinemia.
Materials and Methods: A prospective observational study was conducted at a tertiary hospital in Puducherry (Apr 2023–Apr 2024) after ethical approval. Term newborns meeting inclusion criteria were consecutively enrolled (n=70). Cord blood bilirubin and albumin were measured at birth; bilirubin was reassessed at 72 hours, with management per AAP 2022 guidelines. Data were analyzed using SPSS v22 with descriptive statistics, Chi-square/Fisher's exact test, Mann-Whitney U test, and Spearman's correlation; p<0.05 was considered significant.
Results: Among 70 neonates, most were delivered vaginally (61.4%) with a slight male predominance (57.1%). Mean birth weight was 2.95 kg and mean gestational age 38.4 weeks. Average cord bilirubin was 1.98 mg/dL and albumin 2.89 g/dL. A significant association was found between a cord bilirubin/albumin ratio >0.7 and hyperbilirubinemia (p=0.037), while cord bilirubin ≥1.9 mg/dL alone was not predictive. Spearman analysis showed a weak correlation between cord bilirubin and total serum bilirubin (ρ=0.2276, p=0.0581) and no significant correlation with cord albumin. Overall, the bilirubin/albumin ratio demonstrated better predictive value than individual parameters.
Conclusion: This study demonstrates that individual cord blood bilirubin (≥1.9 mg/dL) and albumin levels were not significantly associated with neonatal hyperbilirubinemia. However, the bilirubin/albumin ratio >0.7 showed a significant correlation (p=0.037), indicating superior predictive value compared to single parameters. The findings suggest that combined markers, particularly the B/A ratio, may enhance early risk stratification and guide preventive strategies for neonatal hyperbilirubinemia. Larger studies are warranted to validate these results and support uniform screening protocols.
Keywords: Neonatal hyperbilirubinemia, Serum total bilirubin, cord blood bilirubin, cord blood albumin.
How to cite this article: Mohanapriya CS, Kulandaivel M, Gunalan A, Vijayabharathi E, Latha V. Early Predictors of Neonatal Hyperbilirubinemia in a Full-Term Newborn in Tertiary Care Hospital – A Prospective Observational Study. Int J Drug Deliv Technol. 2026;16(15s): 648-657. DOI: 10.25258/ijddt.16.15s.75
Source of support: Nil.
Conflict of interest: None