Predictive value of cord blood bilirubin for hyperbilirubinemia in neonates at risk for maternal-fetal blood group incompatibility and hemolytic disease of the newborn

摘要

OBJECTIVE: To determine the predictive ability of cord blood bilirubin (CBB) for hyperbilimbinemia 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 +- 0.4mg/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.