Original Research Article

Evaluation of Cord Serum Albumin Level as a Risk

Indicator in Predicting Neonatal Jaundice
Venkatamurthy M1, Murali S M1, Hemachandra K1

Abstract:
Objective: To predict the development of Neonatal Hyperbilirubinemia (NH) at birth using Cord Serum
Albumin (CSA) as a risk indicator. Methodology: Prospective study was performed on 174 healthy term
neonates. Cord blood was collected from the healthy term neonates and CSA measured. Neonate was as-
sessed clinically daily. Total serum bilirubin and direct serum bilirubin were measured during 72-96 hours
of life and value ≥17mg/dl is considered NH. Result: Study cohorts are grouped in Group 1, Group 2, and
Group 3 based on Cord Serum Albumin level ≤2.8g/dl, 2.9-3.3g/dl, and ≥3.4g/dl, respectively. Statistical anal-
ysis was done for correlation of CSA with NH. It showed that cord serum albumin level ≤2.8g/dl is critical,
as it was seen in 95% of neonates who developed neonatal hyperbilirubinemia. Conclusion: There is a cor-
relation between Cord serum albumin level and neonatal hyperbilirubinemia. Cord serum albumin level of
≤2.8 g/dl is a risk indicator in predicting the development of neonatal hyperbilirubinemia at birth.
Keywords: Cord Serum Albumin; Neonatal Hyperbilirubinemia; Prediction; Neonates.

INTRODUCTION looked or delay in recognition, un- MATERIALS AND

less the baby is closely monitored.
METHODS

N
eonatal Hyperbiliru- Concern of paediatrician re-
binemia (NH) is com- This prospective study was
garding the early discharge are re-
monest abnormal conducted in Adichunchanagiri
ports of bilirubin induced brain
physical finding during the first Institute of Medical Sciences, Bel-
damage occurring in healthy term
week of life. Serum bilirubin over lur. The study cohort consists of
infants even without haemolysis
15 mg% is found in 3% of normal 174 randomly selected eligible
and the consequence of which is a
term neonates.1 In significant term neonates delivered at our
serious sequel. 4,5
number (6.5%) of babies, Neonatal hospital from December 1 2011 to
Physical examination is not a
Hyperbilirubinemia (NH) is the May 31 2013. Inclusion criteria:
reliable measure of serum biliru-
most common cause for readmis- Term babies both genders, Mode
bin. By predicting the neonates at
sion during the early neonatal pe- of delivery (normal and C-sec-
risk for significant NH early at
riod2. American Academy of Pae- tion), Birth weight ≥2.5kg, and AP-
birth, we can design and imple-
diatrics recommends that neonate GAR ≥7/10 at 1 min. Exclusion cri-
ment the follow-up programme in
discharged within 48 hours should teria: Preterm, Rh incompatibility,
these risk groups, cost effectively.
have a follow-up visit after 48 to 72 Neonatal sepsis, Instrumental de-
Hence, this study was conducted
hours for any significant jaundice livery (forceps and vacuum), Birth
to study the association between
and other problems.3 This recom- asphyxia, Respiratory distress,
various levels of cord blood albu-
mendation is not appropriate for Meconium stained amniotic fluid,
min and significant neonatal hy-
our country due to limited follow- and Neonatal jaundice within 24
perbilirubinemia and to find better
up facilities in the community or Hours of life.
predicator among clinical varia-
jaundice which may be over Demographic profile and rele-
bles.
vant maternal information was
collected by interviewing the
1Department of Paediatrics, Adichunchanagiri Institute of Medical Sciences, mother and from mother’s case
B.G.Nagara, Mandya, Karnataka, India. sheet. 2ml of Cord blood was col-
Address for Correspondence: Dr Venkatamurthy M, Professor, Dept. of Paediat- lected during delivery from pla-
rics, Adichunchanagiri Institute of Medical Sciences, B.G.Nagara, Mandya, Kar- cental end and sent for cord serum
nataka, India. albumin estimation. Gestational
email: drvenkatamurthy9@gmail.com age was assessed by using New
Ballard score. All the babies were
followed up daily for first 4 post-
natal days and babies were daily
International Journal of Health Information and Medical Research Vol: 1, Issue: 1, Jan 2014 9
assessed for NH and its severity. RESULTS The study cohort consisted of
Total Serum Bilirubin (TSB) esti- Study cohort consisted of 174 98 male and 76 female babies. The
mation was done at 72-96 hours of neonates who fulfilled the inclu- neonatal hyperbilirubinemia (≥
age for all neonates. sion criteria. 17mg/dl) is independent of the sex
Cord blood collected at birth Study group was divided of the neonate. Amar Taksande et
was analysed by auto analyser based on cord serum albumin al study on 200 neonates with 82
method (Erba EM 200) for Cord level in to 3 groups (Table I). males and 118 females also found
Serum Albumin estimation. Se- The demographic variables no correlation between the sex of
rum bilirubin estimation was done and the variables, which influence the neonate and the neonatal hy-
by Diazotized sulfanilic test. neonatal hyperbilirubinemia di- perbilirubinemia (≥17mg/dl).8
The main outcome of the study rectly or indirectly, were com- In our study, there is no signif-
was inferred in terms of neonatal pared and shown in table II. icant association (p >0.05) between
hyperbilirubinemia. Serum biliru- In table II, statistical signifi- the neonate born to mother who
bin ≥17 mg/dl after 72 hours of life cance is seen between cord serum received oxytocin and neonatal
was taken as significant hyperbili- albumin and neonatal hyperbiliru- hyperbilirubinemia. Out of 174,
rubinemia and treatment advised, binemia. only 105 received oxytocin for in-
as per the American academy of duction of labour. NH developed
paediatrics practice parameter,
DISCUSSION in 11/105 neonates whose mothers
2004. received oxytocin. Oral E et al
Incidence of hyperbiliru-
Data was tabulated in Mi- 2003, in their study regarding ef-
binemia varies from 8.3% to
crosoft Excel and analysed using fect of oxytocin on NH, concluded
12.8%.6,7 Incidence of hyperbiliru-
SPSS 15.0 software package. Pro- no significant effect of oxytocin in-
binemia in our study was 11.5%
portions and Chi square test was fusion on neonatal hyperbiliru-
which correlates with other stud-
used to analyse data. P value less binemia unless it was for the aug-
ies.
than 0.05 was considered signifi- mentation of labour.9 Amar
cant Taksande et al in his study showed
Table I: Groups based on Cord Serum Albumin (g/dl) level. no significant association (p 0.245)
between the Oxytocin induction
Cord Serum Albumin (g/dl) No. of patients %
of labour and neonatal hyperbili-
≤2.8 (Group 1) 81 46.5
rubinemia.7 Our study result is
2.9-3.3 (Group 2) 53 30.5
similar with the studies of Oral E
≥3.4 (Group 3) 40 23.0
et al and Amar Taksande et al re-
Total 174 100.0
garding oxytocin effect on neona-
tal hyperbilirubinemia.
Table II: Correlation of Clinical Variable with Neonatal hyperbiliru-
Sahu et al in 2011 found that
binemia.
70% (14/20) neonates who devel-
Neonatal Hyperbilirubinemia oped significant NH had cord se-
Variables No Yes p value rum albumin level < 2.8 g/dl, 30%
(n=154) (n=20) (6/20) neonates had CSA level 2.9-
Gender 3.3 g/dl, and none of neonates
Male 87(56.5%) 11(55%) 0.899 with CSA level ≥3.4g/dl devel-
Female 67(43.5%) 9(45%) oped NH. There was Statistical
Mode of delivery significance noted between CSA
Cesarean Section 45(29.2%) 6(30%) 0.943 with development of NH (p value
Vaginal route 109(70.8%) 14(70%) <0.001).10 In our study, of the 174
Oxytocin drug use neonates included, 20 neonate de-
No 60(39%) 9(45%) 0.603 veloped NH. In group 1 (CSA
Yes 94(61%) 11(55%) level < 2.8 g/dl) 95% (19/20);
Chord Serum Albumin (mg/dl) Group 2 (CSA level 2.9-3.3 g/dl),
≤2.8 58(37.7%) 19(95%) <0.001** 5% (1/20) and Group 3 (CSA level
2.9-3.3 56(36.4%) 1(5%)
≥3.4 40(26%) 0(0%)

10 International Journal of Health Information and Medical Research Vol: 1, Issue: 1, Jan 2014
≥3.4g/dl), 0% developed NH re-
quiring PT. Our study results cor-
related well with Shau et al.
In our study, infants with neo-
natal hyperbilirubinemia
(≥17mg/dl) had significantly lower
levels of cord serum albumin (≤
2.8g/dl). Therefore, it is possible to
define a group of neonates at risk
of developing jaundice needing
phototherapy at birth based on
CSA.
Cord serum albumin level
≥3.4g/dl can be considered safe, as
none of neonates developed in this
group had significant hyperbiliru-
binemia.
Limitations of the study was
that only full term healthy neo-
nates were taken for the study,
sample size is time based and not
representative, thus requiring fur-
ther study with representative
sample.
CONCLUSION
There is a significant correla-
tion between Cord serum albumin
level and neonatal hyperbiliru-
binemia in healthy term neonates.
Cord serum albumin level of ≤2.8
g/dl can be used a risk indicator in
International Journal of Health Information and Medical Research Vol: 1, Issue: 1, Jan 2014
predicting the development of ne-
onatal hyperbilirubinemia at birth.
Cord serum albumin level ≥3.4g/dl
can be considered safe for early
discharge.
CONFLICT OF INTEREST
None.
ACKNOWLEDGMENTS
Thankful to institution and ne-
onates in the study.
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