Ahmad N, Ahmed U, Mohy Ud Din G, Habib M, Luqman MS, Talha M, Saifullah M, Rana I. Comparison of bilirubin albumin ratio and total serum bilirubin for predicting neurological dysfunction in newborns: A meta-analysis. World J Clin Pediatr 2026; 15(1): 112088 [DOI: 10.5409/wjcp.v15.i1.112088]
Corresponding Author of This Article
Ikra Rana, MD, Department of Medicine, International School of Medicine, International University of Kyrgyzstan, 6 Street, Bishkek 720074, Kyrgyzstan. ikrarana100@gmail.com
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Pediatrics
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Meta-Analysis
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Mar 9, 2026 (publication date) through Mar 9, 2026
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World Journal of Clinical Pediatrics
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2219-2808
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Ahmad N, Ahmed U, Mohy Ud Din G, Habib M, Luqman MS, Talha M, Saifullah M, Rana I. Comparison of bilirubin albumin ratio and total serum bilirubin for predicting neurological dysfunction in newborns: A meta-analysis. World J Clin Pediatr 2026; 15(1): 112088 [DOI: 10.5409/wjcp.v15.i1.112088]
World J Clin Pediatr. Mar 9, 2026; 15(1): 112088 Published online Mar 9, 2026. doi: 10.5409/wjcp.v15.i1.112088
Comparison of bilirubin albumin ratio and total serum bilirubin for predicting neurological dysfunction in newborns: A meta-analysis
Nabeel Ahmad, Uzair Ahmed, Ghulam Mohy Ud Din, Mavia Habib, Muhammad Shaheer Luqman, Muhammad Talha, Muneeb Saifullah, Ikra Rana
Nabeel Ahmad, Uzair Ahmed, Ghulam Mohy Ud Din, Department of Pediatrics, Lahore General Hospital, Lahore 54000, Punjab, Pakistan
Mavia Habib, Department of Cardiology, Services Institute of Medical Sciences, Lahore 54000, Punjab, Pakistan
Muhammad Shaheer Luqman, Department of Medicine, Ameer-Ud-Din Medical College, Lahore 54000, Punjab, Pakistan
Muhammad Talha, Muneeb Saifullah, Department of Medicine, King Edward Medical University, Lahore 54000, Punjab, Pakistan
Ikra Rana, Department of Medicine, International School of Medicine, International University of Kyrgyzstan, Bishkek 720074, Kyrgyzstan
Author contributions: Ahmad N and Ahmed U collected data and drafted the manuscript; Ahmad N, Ahmed U, Mohy Ud Din G, Habib M, Luqman MS, Saifullah M and Rana I conceived the study and contributed to its design; Mohy Ud Din G, Habib M, Talha M and Rana I participated in data analysis and literature review; Luqman MS and Saifullah M contributed to manuscript editing and critical revisions; all authors read and approved the final version of the manuscript.
Conflict-of-interest statement: All authors declare no conflict of interest in publishing the manuscript.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Corresponding author: Ikra Rana, MD, Department of Medicine, International School of Medicine, International University of Kyrgyzstan, 6 Street, Bishkek 720074, Kyrgyzstan. ikrarana100@gmail.com
Received: July 17, 2025 Revised: August 9, 2025 Accepted: October 28, 2025 Published online: March 9, 2026 Processing time: 232 Days and 18.6 Hours
Abstract
BACKGROUND
Bilirubin-induced neurologic dysfunction (BIND) remains a serious complication of severe neonatal hyperbilirubinemia, especially in resource-limited settings. While total serum bilirubin (TSB) is widely used for risk stratification, the bilirubin/albumin (B/A) ratio has been proposed as a surrogate for free bilirubin, the neurotoxic fraction.
AIM
To compare the diagnostic accuracy of the B/A ratio vs TSB for predicting acute BIND in neonates.
METHODS
We conducted a systematic review and meta-analysis of observational studies evaluating the B/A ratio and TSB for predicting BIND in neonates (≥ 35 weeks' gestational age). Data sources included PubMed, EMBASE, Cochrane Central, and Google Scholar. Pooled standardized mean difference (SMD), sensitivity, specificity, and heterogeneity (I2) were calculated using a bivariate random-effects model. Meta-regression was used to assess whether biomarker type (B/A vs TSB) explained performance differences. The risk of bias was evaluated using the Quality Assessment of Diagnostic Accuracy Studies-2 tool.
RESULTS
Five studies involving a total of 1022 neonates were included, with a male-to-female ratio of approximately 57:40. The SMD for B/A ratio was 1.71 (95%CI: 1.00–2.41, P < 0.0001), and for TSB it was 1.68, both showing strong associations with BIND. Meta-regression revealed no significant difference in predictive value between the two biomarkers (P = 0.96).
CONCLUSION
Both TSB and the B/A ratio are comparably effective in predicting BIND. While the B/A ratio may provide incremental value in specific clinical contexts, current evidence supports continued reliance on TSB for routine risk stratification.
Core Tip: Bilirubin-induced neurologic dysfunction (BIND) remains a preventable cause of neonatal brain injury, yet early risk stratification is challenging. We conducted a meta-analysis of observational studies using clinical criteria to diagnose BIND and found that elevated serum bilirubin/albumin (B/A) ratio is significantly associated with increased risk of BIND. This association remained robust across subgroup and meta-regression analyses. Our findings support the B/A ratio as a simple, accessible biomarker that may improve clinical prediction of BIND and guide early intervention in jaundiced neonates.
