Umbilical cord blood bilirubins, gestational age, and maternal race predict neonatal hyperbilirubinemia

Objective: No validated biomarker at birth exists to predict which newborns will develop severe hyperbilirubinemia. This study’s primary aim was to build and validate a prediction model for severe hyperbilirubinemia using umbilical cord blood bilirubins (CBB) and risk factors at birth in neonates at risk for maternal-fetal blood group incompatibility. This study’s secondary aim was to compare the accuracy of CBB to the direct antigen titer. Methods: Inclusion criteria for this prospective cohort study included: ≥35 weeks gestational age, mother with blood type O and/or Rh negative or positive antibody screen, and 95th and >75th percentile during the initial hospital stay. The predictive performance and accuracy of the two tests (CBB and direct antigen titer) for each outcome was assessed using area under a receiver-operating characteristic curve (AUC), sensitivity, and specificity. Results: When compared to neonates who did not receive phototherapy (n = 463), neonates who received phototherapy (n = 36) had a greater mean CBB ± standard deviation (2.5 ± 0.7 vs. 1.6 ± 0.4 mg/dL, p 95th and >75th percentile, respectively. The AUC ± standard error (95% confidence interval) for CBB for phototherapy and a total serum bilirubin concentration >95th and >75th percentile was 0.89 ± 0.03 (0.82–0.95), 0.81 ± 0.04 (0.73–0.90), and 0.84 ± 0.02 (0.80–0.89), respectively. However, the AUC for gestational age and maternal Asian race for these outcomes was only 0.55 ± 0.05 (0.45–0.66), 0.66 ± 0.05 (0.56–0.76), and 0.57 ± 0.04 (0.05–0.64), respectively. When the CBB was combined with gestational age and maternal Asian race, the AUC for a total serum bilirubin concentration >95th percentile improved to 0.87 ± 0.03 (0.81–0.92) (p = 0.034 vs. the model with CBB only and p