Umbilical cord blood base deficit predicts the development of hyperbilirubinemia in healthy term and near term newborns

Background and aims The recognition, follow up, and early treatment of neonatal jaundice has become more difficult, since early discharge of newborns from hospital has become common practice. This prospective study was undertaken to test the predictivity of cord blood acidemia at birth for developing significant hyperbilirubinemia at 36 hours of life. Methods A total of 537 healthy termand near termnewborns admitted in Maternity Ward of Policlinico Abano Terme (Italy) underwent total serum bilirubin (TSB) neonate predischarge measurement. Neonates with TSB ≥9 mg/dl at 36 hours of life were defined to have significant hyperbilirubinemia, level ≥75% on TSB nomogram of Bhutani et al. (Pediatrics 1999;103:6–14). Results 133 of 537 newborns (24.8%) screened had TSB ≥9 mg/dl at 36 hours of live, high intermediate “risk zone”. When the hemogasanalysis component levels of the newborns who did and who did not developed significant hyperbilirubinemia were compared, those who later developed significant hyperbilirubinemia had significantly higher lactacidemia levels and lower HCO3 and deficit base levels at birth. In addition, logistic regression analysis showed that base deficit significantly predicts (OR=0.593, p=0.005) the risk of significant hyperbilirubinemia and the hyperbilirubinemia risk increases by 40% with the increase of 1 mEq/l of base deficit. [HCO3 20.71, ± 2.37 versus 21.29, ±2.25; p=0.01; BE -3.52, ±3.18 versus -2.68 ,±3.26; p=0.01]. Conclusions In conclusion umbilical cord blood gas analysis is a reliable diagnostic test for intrapartrum hypoxic stress, with significant predictive estimate regarding bilirubin risk zone on an hour specific bilirubin nomogram in healthy neonates.