Indian Journal of Medical Biochemistry

Register      Login

VOLUME 28 , ISSUE 2 ( May-August, 2024 ) > List of Articles


Umbilical Cord Blood Bilirubin as a Predictor of Significant Hyperbilirubinemia Requiring Phototherapy among Full-term Healthy Neonates: A Prospective Study

Preethi B Patil, Prasanna Saka, Abhay K Chidananda

Keywords : Cord blood bilirubin, Full-term neonates, Neonatal hyperbilirubinemia, Phototherapy, Serum total bilirubin

Citation Information : Patil PB, Saka P, Chidananda AK. Umbilical Cord Blood Bilirubin as a Predictor of Significant Hyperbilirubinemia Requiring Phototherapy among Full-term Healthy Neonates: A Prospective Study. Indian J Med Biochem 2024; 28 (2):31-35.

DOI: 10.5005/jp-journals-10054-0231

License: CC BY-NC 4.0

Published Online: 18-05-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Aim and background: Jaundice is a clinical condition characterized by transient bilirubin conjugation deficiency resulting in neonatal hyperbilirubinemia. Hyperbilirubinemia is defined as a serum total bilirubin concentration greater than 95th centile for the hour of life. Approximately 60% of term and 80% of preterm infants are affected with hyperbilirubinemia, which may lead to complications such as brain neuron damage after several years. Early discharge of healthy-term newborns after delivery has become a common practice, which may be the cause for readmission during the early neonatal period. Universal follow-up within 1–2 days of early discharge, pre-discharge serum total bilirubin, transcutaneous bilirubin measurement, and universal clinical assessment of risk factors of developing jaundice are various strategies to predict significant neonatal hyperbilirubinemia. An association between cord blood bilirubin levels and subsequent risk of neonatal hyperbilirubinemia has been reported. However, the utility of cord blood bilirubin as a screening test to predict subsequent hyperbilirubinemia has been widely debated. We aimed to verify whether cord blood bilirubin at birth could be used as a predictor of significant neonatal hyperbilirubinemia requiring phototherapy among full-term neonates. Materials and methods: Cord blood bilirubin was estimated in 110 neonates immediately after delivery. These neonates were followed up for the next 3 days and serum total bilirubin was estimated on the third day of life. Neonates with significant hyperbilirubinemia requiring phototherapy were designated as cases and those without hyperbilirubinemia as controls. The association between cord blood bilirubin and serum total bilirubin was determined followed by the identification of the cut-off level of cord blood bilirubin that could predict significant neonatal hyperbilirubinemia requiring phototherapy among term neonates. Results: Among 100 neonates followed up, 50 developed significant hyperbilirubinemia requiring phototherapy. The mean ± SD of cord blood bilirubin was 2.66 ± 0.65 and serum total bilirubin estimated on day 3 of life was 16.16 ± 1.6 and the difference was statistically highly significant at a p-value of <0.00 with paired t-test. The cord blood bilirubin and day 3 serum bilirubin were positively correlated with an r-value of 0.087. The specificity and sensitivity with cord blood bilirubin of 2.5 mg/dL were 98 and 56%, and with day 3 bilirubin of 11.5 mg/dL was 72 and 100%, respectively. Conclusion: A cut-off of 2.5 mg/dL in cord blood bilirubin can be used to predict significant neonatal hyperbilirubinemia requiring phototherapy among full-term neonates. Clinical significance: Umbilical cord blood bilirubin measurement is a simple, economical, and non-invasive method to predict subsequent neonatal hyperbilirubinemia which can aid clinicians in early discharge of normal neonates and selective follow-up of high-risk infants.

PDF Share
  1. Maisels MJ. Neonatal Jaundice. Pediatr Rev 2006;27(12):443–454. DOI: 10.1542/pir.27-12-443.
  2. Kaplan M, Muraca M, Hammerman C. Imbalance between production and conjugation of Bilirubin: A fundamental concept in the mechanism of neonatal jaundice. Pediatrics 2002;110(4):47. DOI: 10.1542/peds.110.4.e47.
  3. Agarwal R, Kaushal M, Aggarwal R, et al. Early neonatal hyperbilirubinemia using first-day serum bilirubin level. Indian Pediatr 2002;39(8):724–730. PMID: 12196683.
  4. Nahar Z, Shahidullah MD, Mannan A, et al. The value of umbilical cord blood bilirubin measurement in predicting the development of significant hyperbilirubinemia in healthy newborns. Bangladesh Journal of Child Health 2009;33(2):50–54. DOI: 10.3329/bjch.v33i2.5677.
  5. Bhutani VK, Johnson L, Sivieri EM. Predictive ability of predischarge hour-specific serum bilirubin for subsequent significant hyperbilirubinemia in healthy term and near-term newborns. Pediatrics 1999;103(1):6–14. DOI: 10.1542/peds.103.1.6.
  6. Higgins T, Bentler E, Doumas BT. Hemoglobin, iron and bilirubin. In: Burtis CA, Ashwood ER, Bruns DE (eds). Tietz Fundaments of Clinical Chemistry. 6th edition. St. Louis, Missouri: Elsevier; 2008, pp. 524–525.
  7. Zeitoun AA, Elhagrasy HF, Abdelsatar DM. Predictive value of umbilical cord blood bilirubin in neonatal hyperbilirubinemia. Egyptian Pediatric Association Gazette 2013:61(1):23–30. DOI:
  8. Martin CR, Cloherty JP. Neonatal hyperbilirubinemia. In: Cloherty JP, Eichenwald EC, Stark AR (eds). Manual of Neonatal care. 6th Edition. Philadelphia: Lippincott Williams & Wilkins. 2008:181–212.
  9. Singhal PK, Singh M, Paul VK, et al. Spectrum of neonatal hyperbilirubinemia: An analysis of 454 cases. Indian Pediatr 1992;29(3): 319–325. PMID: 1612673.
  10. Bernaldo AJ, Segre CA. Bilirubin dosage in cord blood: Could it predict neonatal hyperbilirubinemia? Sao Paulo Med J 2004;122(3):99–103. DOI: 10.1590/s1516-31802004000300005.
  11. Taksande A, Vilhekar K, Jain M, et al. Prediction of the development of neonatal hyperbilirubinemia by increased umbilical cord blood bilirubin. Ind Medica 2005;9(1):5–9. Available from:
  12. Gupta N, Taran SJ, Gupta S, et al. Role of cord blood albumin and bilirubin for prediction of significant neonatal jaundice. Journal of Nepal Paediatric Society 2021;41(2):239–246. DOI: 10.3126/jnps.v41i2.30383.
  13. Vasudevan J, Reddy GMM, Thayumanavan S. Usefulness of cord blood bilirubin as a screening test to predict newborn at risk of hyperbilirubinemia. Pediatr Oncall J 2013;10(3):76–80. DOI: 10.7199/ped.oncall.2013.50.
  14. Rostami N, Mehrabi Y. Identifying the newborns at risk for developing significant hyperbilirubinemia by measuring cord bilirubin levels. J Arab Neonatal Forum 2005;2:81–85. Available from:
  15. Reddy JM, Umesh J. To study the predictive value of umbilical cord blood bilirubin levels term neonates as markers of neonatal hyperbilirubinemia. Int J Res Rev 2021;8(6):18–23. DOI: 10.52403/ijrr.20210603.
  16. Rehna T, Shiyas KP. Comparison of umbilical cord blood bilirubin and bilirubin albumin ratio in predicting neonatal hyperbilirubinemia: A prospective observational study. Journal of Neonatal Medicine and Research 2012;9(4):5–9. DOI: 10.7860/IJNMR/2021/52782.2313.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.