Presented at the Neonatal Society 2012 Autumn Meeting.
Grossman S1,2, Jones KDJ1, Kumaranayakam D1,2, Rao A1, Fegan G3, Aladangady N1,2
1 Homerton University Hospitals NHS Foundation Trust, London, UK
2 Barts and the London School of Medicine & Dentistry, Queen Mary, University of London
3 Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford
Background: Neonatal jaundice is well recognised as one of the commonest causes of admission to hospital in the neonatal period amongst term babies in all settings, and is associated with substantial morbidity (1-3). Although with prompt and effective management the incidence of Kernicterus is very low (4), the devastating nature of this condition coupled with the substantial economic burden of jaundice-related hospitalisations means that strategies to improve early recognition of clinically significant hyperbilirubinaemia remain a public health priority.
Objectives: To assess whether arterial umbilical cord bilirubin (aUCB) level at delivery predicts the development of clinically significant neonatal jaundice in term infants.
Methods: Retrospective analysis of hospital biochemistry records between February – November 2010 identified term deliveries with recorded aUCB. Infant medical records were reviewed to identify those who developed clinically significant neonatal hyperbilirubinaemia with/without a positive direct antiglobulin test (DAT), or sepsis according to clinical criteria. The study was approved by the UK National Research Ethics Service (NRES) Committee London – Harrow (reference 11/LO/0796).
Results: Of 1411 term deliveries with a clearly recorded aUCB, 30 infants developed clinically-significant jaundice (2.7%), of whom 8 were DAT+ve (0.6%) mostly due to ABO incompatibility, and 42 developed clinically-defined sepsis. aUCB strongly predicted the development of DAT+ve jaundice (area under the ROC curve = 0.996), as well as all-cause jaundice (area under the ROC curve = 0.74). However, this effect was critically dependent on maternal blood group. Amongst infants at risk of ABO incompatibility (maternal blood groups O+ve/O-ve, 43.8%) the predictive value of aUCB for all cause jaundice was strengthened (area under the ROC curve = 0.88). Amongst those not at risk (maternal blood group not O+ve/O-ve, 53.1%) it disappeared completely (area under the ROC curve = 0.46). aUCB had no predictive value for sepsis.
Conclusion: For infants of mothers with blood group O, aUCB predicts development of neonatal jaundice. There was no evident utility for infants of mothers with different blood groups. Estimation of aUCB should be considered as a strategy for early identification of those at risk of neonatal haemolytic jaundice.
Corresponding author: sophie.grossman8@gmail.com
References
1. Sarici S U et al. Pediatrics 2004;113:775–780.
2. Escobar GJ et al. Arch Dis Child. 2005;90(2):125-131.
3. Mwaniki MK et al. BMC Public Health. 2010;10:591.
4. Johnson L et al. J Perinatol. 2009;29:S25-45.