Predictive value of cord blood bilirubin for hyperbilirubinemia in neonates at risk for maternal-fetal blood group incompatibility and hemolytic disease of the newborn
Affiliations: [a] Department of Pediatrics, Division of Neonatology and Developmental Biology, Neonatal Research Center, David Geffen School of Medicine, University of California, and Mattel Children’s Hospital at UCLA, Los Angeles, CA, USA | [b] Department of Medicine, Statistics Core, David Geffen School of Medicine, University of California and Mattel Children’s Hospital at UCLA, Los Angeles, CA, USA
Correspondence:
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Corresponding author: Kara L. Calkins, MD, 10833 LeConte Avenue, Room B2-352, MDCC, Los Angeles, CA 90095-1752, USA. Tel.: +1 310 825 9330; Fax: +1 310 267 0154; KCalkins@mednet.ucla.edu
Abstract:
OBJECTIVE: To determine the predictive ability of cord blood bilirubin (CBB) for hyperbilirubinemia in a population at risk for maternal-fetal blood group incompatibility and hemolytic disease of the newborn.
STUDY DESIGN: This is a single center retrospective case-control study. Cases received phototherapy; controls did not. Cases were matched 1:3 to controls by gender and treating physician. Inclusion criteria included: ≥35 weeks gestation, CBB, and one or more total serum bilirubin (TSB) concentrations. The primary outcome was CBB. Secondary outcomes were a TSB >75th percentile, length of stay, and neonatal intensive care unit admission. The prognostic ability of CBB for phototherapy and TSB >75th percentile was assessed using area under the receiver operating characteristic (ROC) curve. Logistic regression analyses were performed to determine predictors for phototherapy and TSB >75th percentile.
RESULT: When compared to controls (n = 142), cases (n = 54) were more likely to have a positive Coombs’ test (82% vs. 41% , p < 0.001) and TSB >75th percentile (85% vs. 21% , p < 0.001). When compared to controls, cases had a higher mean (±SD) CBB (2.5 ± 0.5 vs. 1.8 ± 0.4 mg/dL, p < 0.001). The area under the ROC curve (±SEM) for CBB for phototherapy and TSB >75th percentile was 0.87 ± 0.03 (p < 0.001, 95% CI 0.82, 0.93) and 0.87 ± 0.03 (p < 0.001, 95% CI 0.82, 0.92), respectively.
CONCLUSION: In this study, the mean CBB concentration was higher in neonates who received phototherapy compared to those who did not. CBB concentrations may help predict severe hyperbilirubinemia and phototherapy in a population at risk for hemolytic disease of the newborn.
