Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 23199

AbstractMaterial and MethodsResultsDiscussionConclusionReferencesDOI and Others
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2023 | Month : January | Volume : 17 | Issue : 1 | Page : SC16 - SC19 Full Version

Umbilical Cord Bilirubin as a Predictor of Neonatal Jaundice in Babies with ABO Blood Group Incompatibility versus without Incompatibility


Published: January 1, 2023 | DOI: https://doi.org/10.7860/JCDR/2023/59836.17341
Cuddalore Subramanian Arulparithi, s manjani, Jane Allen Christa, C Bhuvanesh, Karthikeyan Monica, Dande Naga Mahesh

1. Associate Professor, Department of Paediatrics, Vinayaka Mission Medical College, Karaikal, Pondicherry, India. 2. Associate Professor, Department of Pathology, Bhaarath Medical College, Chennai, Tamil Nadu, India. 3. Senior Resident, Department of Paediatrics, Vinayaka Mission Medical College, Karaikal, Pondicherry, India. 4. Senior Resident, Department of Paediatrics, Vinayaka Mission Medical College, Karaikal, Pondicherry, India. 5. Senior Resident, Department of Paediatrics, Vinayaka Mission Medical College, Karaikal, Pondicherry, India. 6. Junior Resident, Department of Paediatrics, Vinayaka Mission Medical College, Karaikal, Pondicherry, India.

Correspondence Address :
Dr. S Manjani,
25, Ricky Garden, 3rd Cross Street, IAF Road, Karaikal, Pondicherry, India.
E-mail: cs_arulparithi@yahoo.co.in

Abstract

Introduction: Severe hyperbilirubinaemia cause long-term morbidity that can be prevented by early prediction of the development of significant jaundice by measuring Umbilical Cord Bilirubin (UCB).

Aim: To measure the predictability of UCB as an early marker of development of significant hyperbilirubinaemia needing phototherapy.

Materials and Methods: The study was a prospective observational study conducted at Vinayaka Mission Medical College, Karaikal, Pondicherry, India. A total of 50 babies born between February and August 2022 were included in the study. Bilirubin levels were obtained at birth by umbilical cord sampling and rechecked again at third or fourth day. Blood group incompatibility was defined as A or B blood group babies born to O group mothers. Phototherapy was started when the bilirubin levels were above or upto 2 mg/dL below the cut-off for that patient as indicated by the curve for the risk group of the patient as per the American Academy of Paediatrics (AAP) guidelines. Phototherapy also was started if clinically indicated by visual assessment by Kramers rule.

Results: Results were analysed by Receiver Operating Characteristics (ROC) curve analysis for measurement of sensitivity and specificity for predicting significant neonatal hyperbilirubinaemia. ROC curve anlaysis revealed that a cut-off of UCB of 1.95 mg/dL resulted in an accepatable sensitivity and specificity for predicting significant jaundice requiring phototherapy at 75% and 68% respectively. ROC curve analysis revealed that Area Under Curve (AUC) for UCB levels of all babies for predicting jaundice requiring treatment was 0.765, 95% CI 0.592 to 0.937. Separate ROC analysis showed that AUC for UCB for predicting phototherapy in babies with blood group incompatibility (AUC 0.80, 95% CI 0.418 to 1.00) was more significant than the AUC for babies without blood group incompatibility (AUC 0.490, 95% CI 0.29 to 0.69).

Conclusion: UCB has high predictability for significant jaundice requiring phototherapy. The prediction is more when babies with blood group incompatibility is considered compared to babies without blood group incompatibility.

Keywords

Blood group incompatibility, Hyperbilirubinaemia, Umbilical cord bilirubin

Clinical jaundice occurs in 85% of term and preterm newborns (1). Physiologic jaundice and other causes like breast feeding jaundice and breast milk jaundice accounts for the majority of cases. Other causes include immune and non immune haemolytic anaemias, genetic disorders of bilirubin clearance, metabolic and endocrine disorders. ABO incompatibility usually occurs in A or B blood group infants born to O group mothers. It doesn’t usually occur in A or B group infants born to B or A group mothers respectively because the antibodies are of the IgM type (2). Bilirubin is the end product of haeme catabolism which circulates in the blood after being reversibly bound to albumin (3). Upon uptake in the liver, bilirubin is conjugated by the enzyme Uridine diphosphate (UDP) glucuronyl transferase and excreted in the bile. Increased production of bilirubin accounts for the physiologic jaundice. In addition, in babies with ABO incompatibility in utero haemolysis occurs due to transplacental transfer of IgG antibodies. Hence it is predicted that measurement of UCB at birth can detect a significant proportion of infants which later develop pathologic jaundice requiring phototherapy.

Neonatal hyperbilirubinaemia is a common condition in newborn and severe hyperbilirubinaemia can lead to long-term morbidity if not recognised and treated early (1). Several methods are proposed to predict the likelihood of developing significant hyperbilirubinaemia. Of these UCB, Umbilical Cord Albumin (UCA) and bilirubin-albumin ratio are proposed as useful indices (4). Though measurement of free bilirubin (which is an ideal indicator for development of hyperbilirubinaemia and neurotoxicity) is not available, other indices like Umbilical Blood Bilirubin (UBB), UCA and bilirubin-albumin ratio can serve as a useful surrogate markers for developing significant hyperbilirubinaemia. It was found long before that there is an association between UCB and peak postnatal bilirubin levels (5),(6),(7). Categorisation of infants into high and low-risk groups based on the UCB levels helps to focus attention on high-risk groups thereby preventing early discharge and preventing complications of hyperbilirubinaemia (8). Infants categorised into low risk groups can be discharged early, thereby preventing unnecessary care (9). The use of a non invasive test like UBB and other risk factors like maternal Asian race and gestational age can be used to predict severe hyperbilirubinaemia risk (10). Though UCB samples are routinely done in babies born to Rh negative mothers, its application in babies at risk of ABO incompatibility especially in Indian population needs to be studied. The study was aimed at examining the usefulness of UCB in predicting the need for phototherapy in babies with ABO blood group incompatibility versus without incompatibility.

Material and Methods

The study was conducted as a prospective study in a tertiary care hospital, from February to August 2022. The study was approved by the Institutional Ethical Committee (IEC) of Vinayaka Mission Medical College and Hospital, Karaikal (VMMC/PEAD/2022/July/06). Sample size was calculated as per convenience sample.

Inclusion criteria: Term babies (>37 weeks) born by either natural delivery or Caesarean section were included in the study.

Exclusion criteria: Preterm babies and babies with other risk factors like Rh incompatibility sepsis, cholestasis, respiratory distress syndrome, meconium aspiration syndrome and babies with haemodynamic instability were excluded from the study.

Term babies without these risk factors born during the time period were enrolled and umbilical blood samples were collected after obtaining informed consent from the parents. Samples were processed for bilirubin and blood grouping and typing. Mothers blood grouping and Rh typing was also done. In addition, data like gestational age and parity were also obtained. Bilirubin levels were obtained for babies on 3rd or 4th day as per clinical judgement of jaundice by Kramers rule (11). Peak postnatal bilirubin levels were noted on the third or fourth day which better correlated with UCB levels. Significant hyperbilirubinaemia is defined as bilirubin levels requiring phototherapy as per AAP guidelines for phototherapy (6). Bilirubin levels above 15 mg/dL or 17 mg/dL for babies without blood group incompatibility on the 3rd or 4th day respectively and levels above 13 mg/dL or 14 mg/dL for babies with ABO incompatibility on the 3rd or 4th day respectively were started on phototherapy. Phototherapy was initiated if Total Serum Bilirubin (TSB) was greater than the cut-off for that patient as indicated by the curve for the risk group of the patient. Phototherapy was also started if TSB was upto 2-3 mg/dL below the cut-off. Also phototherapy was also started if clinically indicated by visual assessment as per Kramers rule.

Statistical Analysis

Statistical analysis was done using ROC curve analysis for sensitivity and specificity of UBB for predicting significant hyperbilirubinaemia requiring phototherapy. Separate ROC curves for babies with and without blood group incompatibility were obtained. Continuous variables were analysed by independent t-test for comparing means. Statistical analysis was done using Statistical Package for the Social Sciences (SPSS) version 26.0.

Results

A total of 95 babies were delivered between February to August 2022. Of these 50 babies were included in the study after exluding preterm babies and babies with other risk factors. Among the included cases, 17 mothers had O group. Of these seven babies had blood group incompatibility. Blood group incompatibility was said to be present when A or B blood babies born to O group mothers. The mean UBB levels of all babies was 1.91±0.51 mg/dL). The mean UBB levels of 43 babies without blood group incompatibility was 1.84±0.51 mg/dL, whereas the mean UBB levels of seven babies with incompatibility was 2.35±0.20 mg/dL. Babies with blood group incompatibility had significantly higher cord bilirubin than babies without blood group incompatibility (p-value <0.05). About 16 babies were treated with phototherapy. Of these 11 babies had no blood group incompatibility whereas five babies had ABO incompatibility. The mean UBB for babies requiring phototherapy was 2.26±0.47 mg/dL, whereas the mean UBB for babies not requiring phototherapy was 1.75±0.45 mg/dL. Babies requiring phototherapy had significantly higher UBB levels than babies not requiring phototherapy (p-value<0.001). ROC curve analysis revealed that there was significant predictability of UBB for phototherapy (AUC 0.765, 95% CI 0.592 to 0.937). The analysis showed that a cut-off of 1.95 mg/dL has a sensitivity of 75% and specificity of 68% in predicting the need for phototherapy. Separate analysis of ROC curves for babies with and without blood group incompatibility revealed that the predictability for phototherapy is lost in babies without blood group incompatibility (AUC 0.490, 95% CI 0.29 to 0.69) when compared to babies with blood group incompatibility (AUC 0.80, 95% CI 0.418 to 1.00). UCB levels are not predictive for phototherapy when babies without blood incompatibility were considered separately as shown by the ROC analysis (Table/Fig 1),(Table/Fig 2),(Table/Fig 3). This could be due to smaller sample size of the present study.

Discussion

The present study demonstrated that UCB could be a useful predictor for later development of significant jaundice requiring phototherapy especially in babies with blood group incompatibility. Increased foetal bilirubin production due to haemolysis and decreased clearance of foetal bilirubin by maternal circulation results in elevated bilirubin levels in umbilical cord blood at delivery (11). A combination of transcutaneous bilirubin and UCB can increase the prediction of hyperbilirubinaemia considerably (12). Another study found that post-test probability of UCB increased exponentially in different subgroups characterised by Direct Antiglobin Test (DAT) and ABO incompatibility results (13). The prediction for phototherapy increased significantly with elevated UCB levels in babies at risk of blood group incompatibility and haemolytic disease (6). Early prediction of significant hyperbilirubinaemia by UCB could minimise duration of hospitalisation post delivery (9).

When cord blood bilirubin was combined with gestational age and maternal race, the predictability for babies developing severe hyperbilirubinaemia improved significantly than when UCB was used alone (10). Substantial differences in reported sensitivity and specificity of UCB may be due to different cut-offs used in these studies. UCB could be predictive for development of severe jaundice and need for phototherapy in at risk babies like ABO incompatibility (6). This could minimise prolonged hospital stay and delay in diagnosing and managing significant neonatal jaundice (8). A significant difference in UCB could not be found in babies with Rh incompatibility treated with phototherapy versus babies without Rh incompatibility treated with phototherapy. In another study which compared babies with and without blood group incompatibility it was found that it is a better predictor of jaundice due to haemolytic disease than jaundice due to other causes (14).

Cord blood albumin ≤3 mg/dL had a sensitivity of 85.7% and specificity of 67.3% in predicting significant hyperbilirubinaemia (4). They also concluded that cord bilirubin/albumin ratio cut-off value >0.61 had sensitivity of 100% and specificity of 88.4% in predicting significant hyperbilirubinaemia. Similar study inferred that cord blood albumin cut-off of 3.17 g/dL and 0.719 had sensitivity and specificity of 40.8%, 34.8% for development of hyperbilirubinaemia requiring phototherapy. Also, they showed that cord blood bilirubin/cord blood albumin ratio cut-off of 0.719 had sensitivity and specificity of 97.4% and 62.6% respectively. Hence it is shown that cord blood albumin and cord blood bilirubin/albumin ratio together with cord blood bilirubin could be better predictors than cord blood bilirubin alone for significant jaundice requiring treatment (15).

UCB cut-off of >2 mg/dL had a sensitivity of 76.85% and specificity of 69.58% in detecting hyperbilirubinaemia that develops in the first 48 hours (16). However, the study had not done separate analysis for babies with and without blood group incompatibility (16). Jones KDJ et al., found that predictive value of UCB for all cause jaundice was strong in babies with blood group incompatibility (AUC- 0.88), whereas it was weak (AUC – 0.46) in babies without blood group incompatibility (14).

Other parameters like cord blood Erythropoietin (EPO) and cord blood Reticulocyte Count (RC), when combined with CBB were also sensitive and specific for neonatal hyperbilirubinaemia (17). There was also a significant correlation between cord bilirubin and cord haemoglobin (18). They also found that cHB (cord Haemoglobin) and vaginal delivery were correlated significantly with bilirubin levels >9 mg/dL. Hence they suggested that a UCB should be added as one of the risk factors for neonatal hyperbilirubinaemia. In another study it was concluded that low umbilical cord bilirubin <2.6 mg/dL could predict low risk of hyperbilirubinaemia and early discharge (19). Sun G et al., found that UCB could be a significant predictor of neonatal jaundice (20). Various studies have shown various cut-offs for UCB for prediction of significant jaundice with different sensitivities, specificities, positive predictive value and negative predictive value and is shown in (Table/Fig 4) (4),(8),(9),(15),(16),(17),(19),(20).

Limitation(s)

The present study has limited sample size which was a major limitation. Also other parameters like umbilical cord albumin and bilirubin albumin ratio were not done. Rh incompatibility was excluded since some mothers would not have been sensitised. Minor blood group incompatibility could not be ruled out as testing for minor blood group antigens were not done.

Conclusion

The study highlights the usefulness of UCB in predicting the need for phototherapy especially in babies with blood group incompatibility. This study in contrast to western studies has high prescription rates for phototherapy probably due to Asian ethnicity and high prevalence of breast feeding jaundice and other causes in the Indian population. To extrapolate the findings of the study to the larger Indian population more research involving larger samples are needed.

References

1.
Anne R. Hansen MD, MPH, Ann R. Stark, Eric C Eich. Cloherty and Stark’s Manual of Neonatal Care. South Asia Edition ed. 2021.
2.
Gomella TL, Eyal FG, Bany-Mohammed F. Neonatology Management, Procedures On-Call Problems, Diseases, and Drugs. 8th ed. TRICIA LACY GOMELLA, editor. 2020.
3.
Martin R, Fanaroff A, Walsh M. Fanaroff and Martin’s Neonatal-Perinatal Medicine. 11th ed. 2019.
4.
Khairy MA, Abuelhamd WA, Elhawary IM, Naba ASM. Early predictors of neonatal hyperbilirubinemia in full term newborn. Pediatrics and Neonatology. 2019;60:285-90. [crossref] [PubMed]
5.
Rosenfeld J. Umbilical cord bilirubin levels as a predictor of subsequent hyperbilirubinemia. J Fam Pract. 1986;23:556-58.
6.
Calkins K, Roy D, Molchan L, Bradley LG. Predictive value of cord blood bilirubin for hyperbilirubinemia in neonates at risk for maternal-fetal blood group incompatibility and hemolytic disease of the newborn. J Neonatal Perinatal Med. 8(3):243-50. [crossref] [PubMed]
7.
N R, Mehrabi Y. Identifying the newborns at risk for developing significant hyperbilirubinemia by measuring cord bilirubin levels. J Arab Neonatol Forum. 2005; 2:81-5.
8.
Aktas S, Dogan C, Okmen ZH, Gulec SG. Is cord blood bilirubin level a reliable predictor for developing significant hyperbilirubinemia? Am J Perinatol. 2019; 36(3):317-21. [crossref] [PubMed]
9.
Knüpfer M, Pulzer F, Gebauer C, Robel-Tillig E. Predictive value of umbilical cord blood bilirubin for postnatal hyperbilirubinaemia. Acta Paediatr. 2005;94(5):581-87. [crossref] [PubMed]
10.
Castillo A, Grogan TR, Wegrzyn GH, Ly KV, Walker V. Umbilical cord blood bilirubins, gestational age, and maternal race predict neonatal hyperbilirubinemia. PLoS ONE. 2018;13(6). [crossref] [PubMed]
11.
Knudsen A. Prediction of the development of neonatal jaundice by increased umbilical cord blood bilirubin. Acta Paediatr Scand. 1989;78(2):217-21. [crossref] [PubMed]
12.
Guan H, Li H, Luo J, Lin L, Wang Y. Early predictive value of cord blood bilirubin and dynamic monitoring of transcutaneous bilirubin for hyperbilirubinemia of newborns. Saudi J Biol Sci. 2017;24(8):1879-83. [crossref] [PubMed]
13.
Peeters B, Geerts I, Van Mullem M, Micale. Post-test probability for neonatal hyperbilirubinemia based on umbilical cord blood bilirubin, direct antiglobulin test, and ABO compatibility results. Eur J Pediatr. 2016;175(5):651-57. [crossref] [PubMed]
14.
Jones KDJ, Grossman SE, Kumaranayakam D, Rao A, Fegan G. Umbilical cord bilirubin as a predictor of neonatal jaundice: A retrospective cohort study. BMC Pediatr. 2017;17(1). [crossref] [PubMed]
15.
Sharma IK, Kumar D, Singh A, Mahmood T. Ratio of cord blood bilirubin and albumin as predictors of neonatal hyperbilirubinaemia. Clin Exp Hepatol. 2020; 6(4):384-88. [crossref] [PubMed]
16.
Kardum D, Serdarusic, Biljan B, Santic. Cord blood bilirubin and prediction of neonatal hyperbilirubinemia and perinatal infection in newborns at risk of hemolysis. J Pediatr (Rio J). 2021;97(4):440-44. [crossref] [PubMed]
17.
Elfarargy MS, Al-Ashmawy GM, Abu-Risha S. Study of cord blood levels of erythropoietin, bilirubin and reticulocyte count as early predictors of neonatal hyperbilirubinemia. Endocr Metab Immune Disord Drug Targets. 2021;21(9):1641-48. [crossref] [PubMed]
18.
Zanardo V, Simbi AK, Parotto M, Guerrini P, Severino L, Ferro S, et al. Umbilical cord bilirubin level and pre-discharge hyperbilirubinemia risk. J Matern Fetal Neonatal Med. 2021;34(7):1120-26. [crossref] [PubMed]
19.
Ipek IO, Bozaykut A, Cagril SC, Sezer RG. Does cord blood bilirubin level help the physician in the decision of early postnatal discharge? J Matern Fetal Neonatal Med. 2012;25(8):1375-78. [crossref] [PubMed]
20.
Sun G, Wang YL, Liang JF, Du LZ. Predictive value of umbilical cord blood bilirubin level for subsequent neonatal jaundice. Zhonghua Er Ke Za Zhi. 2007;45(11):848-52.

DOI and Others

DOI: 10.7860/JCDR/2023/59836.17341

Date of Submission: Aug 24, 2022
Date of Peer Review: Oct 29, 2022
Date of Acceptance: Dec 14, 2022
Date of Publishing: Jan 01, 2023

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. No

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Aug 27, 2022
• Manual Googling: Dec 02, 2022
• iThenticate Software: Dec 15, 2022 (8%)

ETYMOLOGY: Author Origin

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)
  • www.omnimedicalsearch.com