Diagnosis and Assessment of Severity of Neonatal Hyperbilirubinæmia in Babylon Governorate, Incorporating Serum Albumin Level As A Sensitive Predictor of Outcome

Abstract

Neonatal jaundice is a common health problem in Iraqi neonates and oriental populations in general. Proper diagnosis and management is crucial to prevent brain damage by high concentrations of bilirubin (kernicterus). Neonatal jaundice is also regarded as the most common cause of hospitalization of neonates. It is widely agreed that the causes of neonatal jaundice is alteration of a panel of physiological factors including rapid postnatal destruction of excess red blood cells, derangement of liver clearance function and prematurity.
This study was designed to reveal the importance of determining serum albumin level as a predictor of liver function in neonates with jaundice. Sixty-four patients were included in this study during a period of four months. A ratio between bilirubin and albumin levels (B/A ratio) was depicted. A B/A ratio of < 2 showed no risk of exchange transfusion as a treatment modality in all four patients aged 5-12 days, noting that there are no neonates aging 2-5 days with a B/A ratio of < 2, reflecting the accelerated course in this age group. A ratio > 4 carried a high risk of exchange transfusion (18 out of 23 in those aging 5-12 days). The grey zone of B/A ratio lying between 2-4 needed further follow up and more clinical determinants to be treated properly, only 5 out 21 were treated by exchange transfusion aging 5-12 days, while only 1 out of 8 aging 2-5 days was subjected to exchange transfusion. It is clear that the B/A ratio is a good indicator of the severity of neonatal jaundice, predicting the modality of treatment options.