Diagnostic Accuracy of Cord Blood Albumin in Predicting Neonatal Hyperbilirubinemia: A Statistical Evaluation

Abstract

 Aim: This study evaluated the diagnostic accuracy of cord blood albumin (CBA) in predicting neonatal hyperbilirubinemia using ROC analysis and identified an optimal CBA threshold for early risk stratification and phototherapy intervention in term newborns. Introduction: Neonatal jaundice affects 60% of term and 80% of preterm newborns, with severe cases risking kernicterus if undetected. Early discharge increases the risk of missed hyperbilirubinemia, especially in low-resource settings. CBA is a potential biomarker for early jaundice prediction, aiding in timely intervention and follow-up. However, variability in CBA cutoff values raises concerns about its diagnostic accuracy, sensitivity, and specificity. Methods: This prospective observational study was conducted at Jagannath Gupta Institute of Medical Sciences and Hospital, Kolkata, over 18 months (July 2022 – December 2023). Eighty term newborns meeting the inclusion criteria were enrolled. CBA levels were measured at birth, and TSB was assessed at 72 hours. The need for PT was determined using AAP guidelines. SPSS version 26 was used for statistical analysis, and ROC curve analysis identified the optimal CBA cutoff for predicting NNH requiring intervention.Results: Among 80 newborns, 13 (16.25%) developed jaundice requiring phototherapy, while none needed exchange transfusion. CBA ≤2.8 g/dL had an 81.8% jaundice risk, whereas CBA ≥3.4 g/dL had none. A negative correlation (r = -0.41, p < 0.00001) confirmed lower CBA predicted higher bilirubin. ROC analysis identified CBA ≤2.9 g/dL as the best cutoff (87.5% sensitivity, 89.07% specificity).Conclusion: CBA ≤2.9 g/dL predicts neonatal jaundice, while CBA ≥3.4 g/dL indicates minimal risk. Measuring CBA at birth enables early detection and intervention, improving neonatal care, especially in resource-limited settings. Routine CBA screening can enhance management, but larger studies are needed to standardize thresholds for universal screening.