Paediatrica Indonesiana

VOLUME 49 November ‡ NUMBER 6

Original Article

Correlation between cord blood bilirubin level and

incidence of hyperbilirubinemia in term newborns
Rudy Satrya, Sjarif Hidayat Effendi, Dida Akhmad Gurnida

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Abstract
Background 'LVFKDUJLQJ KHDOWK\ WHUP QHZERUQV IURP WKH
hospital after delivery at increasingly earlier postnatal ages has
recently become a common practice due to medical, social, and
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of jaundice.
Objective 7RLQYHVWLJDWHWKHFRUUHODWLRQEHWZHHQOHYHORIFRUG
blood bilirubin and development of hyperbilirubinemia among
aundice is a clinical condition that is often
present and constitutes one of the major issues
during neonatal period due to transient bilirubin
conjugation deficiency, including hepatic uptake
and intracellular transport deficiency, and increased
enterohepatic circulation. Although jaundice affects
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KHDOWK\WHUPQHZERUQV
Methods 3URVSHFWLYH REVHUYDWLRQDO VWXG\ ZDV SHUIRUPHG RQ
 KHDOWK\ WHUP QHZERUQV &RUG EORRG ZDV FROOHFWHG IRU WKH
total bilirubin, conjugated bilirubin, unconjugated bilirubin
level measurement and blood group test. Measurements of total
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7KLV FRQGLWLRQ FDQ FDXVH FHOOXODU GDPDJH HVSHFLDOO\
brain neuron damage resulting in neurological problems
after several years or even death.4 American Academy
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Results 6XEMHFWVZHUHFDWHJRUL]HGLQWRK\SHUELOLUXELQHPLDDQG
QRQK\SHUELOLUXELQHPLD QHZERUQV 7KHUH ZDV D FRUUHODWLRQ
EHWZHHQ FRUG EORRG DQG WKH th day bilirubin level. By ROC
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'LVFKDUJLQJ KHDOWK\ WHUP QHZERUQV IURP
the hospital after delivery at increasingly earlier
postnatal ages has recently become a common
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RI
Conclusions 7KHUHLVDFRUUHODWLRQEHWZHHQFRUGEORRGELOLUXELQ
OHYHO DQG K\SHUELOLUXELQHPLD LQ KHDOWK\ WHUP QHZERUQV &RUG
EORRGELOLUXELQOHYHODWRUJUHDWHUWKDQPJG/FDQSUHGLFW
the development of hyperbilirubinemia. [Paediatr Indones.
2009;49:349-54].
Keywords: cord blood, hyperbilirubinemia, early
detection, newborn, jaundice
practice due to medical, social, and economic
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commonly caused by hyperbilirubinemia.6 A study by
Seidman et al6 ,Q8QLWHG6WDWHVVKRZHGWKDW
From the Department of Child Health, Medical School, Padjadjaran
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Reprint requests to: Rudy Satrya, MD, Department of Child Health,
Medical School, Padjadjaran Univeristy, Hasan Sadikin Hospital, Jl.
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(PDLOrd_stry@yahoo.co.id.
Paediatr Indones, Vol. 49, No. 6, November 2009‡349
 Rudy Satrya et al: Cord blood bilirubin level and hyperbilirubinemia

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had to be readmitted to the hospital.67KHSUREOHP
is the recognition of jaundice becomes more difficult.
Severe jaundice, and even kernicterus, can occur in
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Methods
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Perinatology Division, Department of Child Health,
Hasan Sadikin Hospital, Bandung, during the period
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other than breastfeeding hyperbilirubinemia.
Early detection and recognition of risk factors
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the primary prevention of severe hyperbilirubinemia
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try to find another methods such as transcutaneous
bilirubinometry and cord blood bilirubin measurement.
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and has a risk of injury or infection, is not a practical
procedure to be done as a routinely. Examination of
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procedure and can increase early detection coverage to
prevent severe hyperbilirubinemia. :HLQYHVWLJDWHG
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birth and the development of hyperbilirubinemia in the
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in method to ensure the practice of exclusive
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DOO SDUHQWV 7KH VWXG\ ZDV DSSURYHG E\ WKH 7KH
Health Research Ethics Committee, Medical School,
Padjadjaran University, Bandung.
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the inclusion criteria protocol at the delivery. An
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clinical laboratory of Hasan Sadikin Hospital for the
measurement of total bilirubin, conjugated bilirubin,

Figure 1. Nomogram of risk determination in well newborns at 36 or more weeks’ gestational

age with birth weight of 2000 g or more or 35 or more weeks’ gestational age and birth
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350‡Paediatr Indones, Vol. 49, No. 6, November 2009

 Rudy Satrya et al: Cord blood bilirubin level and hyperbilirubinemia

XQFRQMXJDWHG ELOLUXELQ OHYHO UHIHUUHG DV 7%, CB, Table 1. Characteristics of subjects
UBWKHUHDIWHUDQGEORRGJURXSWHVW7KHQHZERUQV Characteristics Hyperbilirubinemia
ZHUH WKHQ IROORZHG XS DFFRUGLQJ WR WKH URXWLQH Yes (n=21) No (n=67) P

neonatal unit admission procedure. Measurement of Gender - n

Male 16 34 0.040
total bilirubin, conjugated bilirubin, unconjugated Female 5 33
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Cesarean 5 17
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perinatology clinic in the outpatient department on B 4 16
O 7 23
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Breast milk 8 39 0.08
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having hyperbilirubinemia and they had to undergo Formula milk 0 4
phototherapy. Gestational age - weeks
Mean (SD) 38.7 (1.42) 39 (1.30) 0.287§
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DVOHYHORI76%DERYHWKHth percentile based on the Birth weight - g
normogram (Figure 1 Blood group incompatibility Mean (SD) 2981(326) 3080(428.3) 0.402§
Range 2500-3600 2500-4170
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Maternal age - yr
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Results
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Paediatr Indones, Vol. 49, No. 6, November 2009‡351

 Rudy Satrya et al: Cord blood bilirubin level and hyperbilirubinemia

Table 2. Bilirubin level in subjects’ cord blood

Bilirubin in Hyperbilirubinemia
cord blood ZM-W P value
Yes (n=21) No (n=67)
Total bilirubin (mg/dL)
Mean (SD) 3.77(1.07) 2.14(0.58) 6.084 <0.001
Median 3.50 2.03
Interval 2.34-6.60 0.90-4.22
Conjugated bilirubin (mg/dL)
Mean (SD) 0.23(0.31) 0.18(0.28) 0.659 0.51
Median 0.0 0.0
Interval 0.0-0.86 0.0-0.87
Unconjugated bilirubin (mg/dL)
Mean (SD) 3.53(1.20) 1.94(0.60) 5.564 <0.001
Median 3.40 1.90
Interval 1.71-6.60 0.80-3.93
SD=Standard deviation; ZM-W= Mann-Whitney test

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Characteristics of subjects are presented in Table 1. risk factors involved in the development of significant
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By ROC analysis (Figure 2LWZDVGHWHUPLQHG of kernicterus in healthy term neonates, and
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detection of hyperbilirubinemia in early discharged
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critical level in cord blood on development of significant .QRZOHGJHRILQIDQWVDWULVNRIGHYHORSLQJMDXQGLFH
hyperbilirubinemia DOORZV VLPSOH ELOLUXELQ UHGXFLQJ PHWKRGV WR EH
Total Bilirubin Critical Level Hyperbilirubinemia implemented before bilirubin levels reach critical
Total
in Cord Blood (mg/dL) Yes (n=21) No (n=67) levels.
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Tabel 4. Logistic regression analysis
development of significant hyperbilirubinemia in the
Variable B SE(B) P OR ILUVWZHHNRIOLIHZLWKVHQVLWLYLW\RIVSHFLILFLW\
%QGHſEKGPV value (95%CI)
Cord total bilirubin 87.60
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ŮOIF. 4.473 0.925 <0.001 (14.3 to 536.68) Bernaldo and Segre found that the critical
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of the need for further treatment by phototherapy,
Constanta -0.824 - -
Model Accuracy: 90.9%
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SE: standard error QHHGLQJWUHDWPHQWZDV,ILWZDVPJGOWKH

352‡Paediatr Indones, Vol. 49, No. 6, November 2009

 Rudy Satrya et al: Cord blood bilirubin level and hyperbilirubinemia

SUREDELOLW\ZHQWXSWR36XQHWDO AAP had reported male gender as one of the minor risk
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References
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Johnson LH. Noninvasive measurement of total serum
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to assess the risk of severe hyperbilirubinemia. Pediatrics.
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hyperbilirubinemia on the development of healthy term
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significant hyperbilirubinemia. Based on the data there
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could not predict the development of significant
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Paediatr Indones, Vol. 49, No. 6, November 2009‡353

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