Cord Blood Alkaline Phosphatase and Albumin as Probable Predictors of Significant Neonatal Jaundice in Healthy Full-Term Infants

Abstract

Background: Hyperbilirubinemia in a neonate may occur in 60 -70 % of term and 80 % of preterm babies. It is known to be associated with significant morbidity like neonatal bilirubin encephalopathy and even death. The concept of prediction of jaundice offers an attractive option to pick up babies at risk of neonatal hyperbilirubinemia. Objective: To assess the predictive value of cord blood alkaline phosphatase (ALP) and cord albumin in development of indirect neonatal hyperbilirubinemia in healthy term infants. Patients and method: This prospective cohort study was conducted at Obstetrics Emergency Department, Menoufia University Hospital and included (100) healthy full-term neonates over a period November 2019 to August 2020. Result: The cord alkaline phosphatase in no jaundice group was (248.63±71.73 U/L) while in jaundice group it was significantly higher (374.98±67.15 U/L, p <0.01). The cord albumin in no jaundice group was (3.72±0.18 g/dl) and in jaundice group it was (2.81±0.31 g/dl) with a highly significant decrease in jaundice group than the no jaundice group (p <0.01). The area under the curve was 0.965, at the cutoff value of alkaline phosphatase more than 315 (U/L), with a sensitivity of diagnosis of jaundice 95.0%, and a specificity 100.0%. Also, the area under the curve was 0.983 at the cutoff value of cord albumin (g/dl) less than 2.82 (g/dl) with sensitivity of diagnosis of jaundice 96.0% and a specificity of 100%. Conclusion: It can be concluded that both cord albumin levels and cord blood alkaline phosphatase in a healthy term neonate can predict the possibility of the neonate who will develop hyperbilirubinemia with a high sensitivity and specificity, with cutoff value less than 2.8 gm/dl for cord albumin and more than 315 U/L for alkaline phosphatase. Hence routine determination of cord albumin along with alkaline phosphatase can be implemented to keep track of at-risk neonates.