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Post-test probability for neonatal hyperbilirubinemia based on umbilical cord blood bilirubin, direct antiglobulin test, and ABO compatibility results

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Abstract

Many hospitals opt for early postnatal discharge of newborns with a potential risk of readmission for neonatal hyperbilirubinemia. Assays/algorithms with the possibility to improve prediction of significant neonatal hyperbilirubinemia are needed to optimize screening protocols and safe discharge of neonates. This study investigated the predictive value of umbilical cord blood (UCB) testing for significant hyperbilirubinemia. Neonatal UCB bilirubin, UCB direct antiglobulin test (DAT), and blood group were determined, as well as the maternal blood group and the red blood cell antibody status. Moreover, in newborns with clinically apparent jaundice after visual assessment, plasma total bilirubin (TB) was measured. Clinical factors positively associated with UCB bilirubin were ABO incompatibility, positive DAT, presence of maternal red cell antibodies, alarming visual assessment and significant hyperbilirubinemia in the first 6 days of life. UCB bilirubin performed clinically well with an area under the receiver-operating characteristic curve (AUC) of 0.82 (95 % CI 0.80–0.84). The combined UCB bilirubin, DAT, and blood group analysis outperformed results of these parameters considered separately to detect significant hyperbilirubinemia and correlated exponentially with hyperbilirubinemia post-test probability.

Conclusion: Post-test probabilities for neonatal hyperbilirubinemia can be calculated using exponential functions defined by UCB bilirubin, DAT, and ABO compatibility results.

What is Known:

• The diagnostic value of the triad umbilical cord blood bilirubin measurement, direct antiglobulin testing and blood group analysis for neonatal hyperbilirubinemia remains unclear in literature.

• Currently no guideline recommends screening for hyperbilirubinemia using umbilical cord blood.

What is New:

• Post-test probability for hyperbilirubinemia correlated exponentially with umbilical cord blood bilirubin in different risk groups defined by direct antiglobulin test and ABO blood group compatibility results.

• Exponential functions can be used to calculate hyperbilirubinemia probability.

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Abbreviations

AAP:

American Association of Pediatrics

AUC:

Area under the receiver-operating characteristic curve

DAT:

Direct antiglobulin test

EDTA:

Ethylenediaminetetraacetic acid

LR:

Likelihood ratio

NPV:

Negative predictive value

PPV:

Positive predictive value

TB:

Total bilirubin

TcB:

Transcutaneous bilirubinometry

UCB:

Umbilical cord blood

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Contribution of co-authors

B. Peeters processed the data and wrote the paper. He performed statistical calculations and gathered all the comments of co-authors and revised the text and the statistical calculations.

I. Geerts revised the text and adding comments.

M. Van Mullem searched data in the GLIMS® laboratory software, revised the text and added comments.

I. Micalessi revised the text and added comments.

V. Saegeman revised the text and the statistical calculations.

J. Moerman revised the text and the statistical calculations.

Author information

Authors and Affiliations

  1. Laboratory of Clinical Chemistry, Imelda Hospital, Imeldalaan 9, 2820, Bonheiden, Belgium

    Bart Peeters, Inge Geerts, Mia Van Mullem, Isabel Micalessi & Jan Moerman

  2. Laboratory Medicine, University Hospital Leuven, Herestraat 49, 3000, Leuven, Belgium

    Veroniek Saegeman

Authors
  1. Bart Peeters
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  2. Inge Geerts
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  3. Mia Van Mullem
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  4. Isabel Micalessi
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  5. Veroniek Saegeman
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  6. Jan Moerman
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Corresponding author

Correspondence to Jan Moerman.

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Funding

No funding was received.

Statement of human rights and ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

Informed consent

For this type of study formal consent is not required.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

Conflict of interest

The authors declare that they have no competing interests.

Additional information

Communicated by Patrick Van Reempts

Revisions received: 2 November 2015; 7 January 2016

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Peeters, B., Geerts, I., Van Mullem, M. et al. Post-test probability for neonatal hyperbilirubinemia based on umbilical cord blood bilirubin, direct antiglobulin test, and ABO compatibility results. Eur J Pediatr 175, 651–657 (2016). https://doi.org/10.1007/s00431-016-2690-1

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  • DOI: https://doi.org/10.1007/s00431-016-2690-1

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