Cord Blood Albumin as a Predictor of Neonatal Jaundice

Abstract

Summary and conclusion J aundice is one of the most common physiologic problems requiring medical attention in the newborn. All infants, term or preterm, healthy or ill, undergo changes in bilirubin metabolism after birth. These normal transitional changes may lead to physiologic jaundice. Some infants have an exaggeration of normal transitional changes or additional health alterations that result in accumulation of excess bilirubin or pathologic jaundice (Kaplan et al., 2008). Although most cases of neonatal hyperbilirubinemia are physiological and do not have serious consequences, toxic levels of bilirubin can lead to neurotoxicity resulting in neurodevelopmental abnormalities such as hearing loss, athetosis and rarely, intellectual deficits (Connolly et al., 1990). So, before discharge, every newborn should be assessed for the risk of developing severe hyperbilirubinemia, and all nurseries should establish protocols for assessing this risk. Such assessment is particularly important in infants who are discharged before the age of 72 hours (AAP subcommittee on hyperbilirubinemia, 2004). The objectives of the present study were therefore to verify whether cord blood albumin at birth could be indicative of jaundice among newborns up to their 4th day. This study was conducted on 60 neonates in delivery room and NICU unit in El Mounira General Hospital. They were classified into 2 groups; group I (neonates with high risk factors for neonatal jaundice) as cases group which included 30 neonates and group II (neonates without any risk factor for neonatal jaundice) as a control group which included also 30 neonates. Investigations done at birth were cord blood albumin level, cord serum bilirubin (direct & indirect). On the 4th day post natal investigations had been done was serum bilirubin (direct & indirect), complete blood picture, reticulocytic count serum, C-reactive protein (CRP), maternal & neonatal blood group and RH,G6PD enzyme assay in infants with history of G6PD deficiency in elder children. In our study we grouped our cases and controls according to their cord albumin level into 3 groups; group (a) which has cord albumin level less than 2.8 gm/dl, group (b) is from 2.8-3.3 gm/dl and group (c) which has cord albumin more than 3.3 gm/dl. In our cases group we found that 85.7% of newborns with cord albumin level less than 2.8 gm/dl developed significant hyperbilirubinemia, 71.4% of them required phototherapy and 14.3% required exchange transfusion. The group of newborns with cord albumin level 2.8-3.3 gm/dl; 76.9% of them developed significant hyperbilirubinemia, 61.5% of them required phototherapy and 15.4% required exchange transfusion. The group of newborns with cord albumin level more than 3.3 gm/dl, only 30% of them developed significant hyperbilirubinemia which required phototherapy and no one required exchange transfusion.