title: Post-test probability for neonatal hyperbilirubinemia based on umbilical cord blood bilirubin, direct antiglobulin test, and ABO compatibility results.
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.
  
  
  CONCLUSIONS
  Post-test probabilities for neonatal hyperbilirubinemia can be calculated using exponential functions defined by UCB bilirubin, DAT, and ABO compatibility results.
  
  
  BACKGROUND
  • 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.
authors.affiliation: Laboratory of Clinical Chemistry, Imelda Hospital, Imeldalaan 9, 2820, Bonheiden, Belgium.
authors.forename: Bart
authors.initials: B
authors.lastname: Peeters
authors.affiliation: Laboratory of Clinical Chemistry, Imelda Hospital, Imeldalaan 9, 2820, Bonheiden, Belgium.
authors.forename: Inge
authors.initials: I
authors.lastname: Geerts
authors.affiliation: Laboratory of Clinical Chemistry, Imelda Hospital, Imeldalaan 9, 2820, Bonheiden, Belgium.
authors.forename: Mia
authors.initials: M
authors.lastname: Van Mullem
authors.affiliation: Laboratory of Clinical Chemistry, Imelda Hospital, Imeldalaan 9, 2820, Bonheiden, Belgium.
authors.forename: Isabel
authors.initials: I
authors.lastname: Micalessi
authors.affiliation: Laboratory Medicine, University Hospital Leuven, Herestraat 49, 3000, Leuven, Belgium.
authors.forename: Veroniek
authors.initials: V
authors.lastname: Saegeman
authors.affiliation: Laboratory of Clinical Chemistry, Imelda Hospital, Imeldalaan 9, 2820, Bonheiden, Belgium. jan.moerman@imelda.be.
authors.forename: Jan
authors.initials: J
authors.lastname: Moerman
mesh_terms: D000017:ABO Blood-Group System / Q000032:analysis*; D001663:Bilirubin / Q000097:blood*; D003298:Coombs Test; D005260:Female; D005312:Fetal Blood / Q000737:chemistry*; D005500:Follow-Up Studies; D006801:Humans; D051556:Hyperbilirubinemia, Neonatal / Q000097:blood* / Q000175:diagnosis; D007231:Infant, Newborn; D008297:Male; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D000017:ABO Blood-Group System; D001663:Bilirubin
keywords: Bilirubin; Hyperbilirubinemia; Jaundice; Umbilical cord blood