Role of Cord Blood Alkaline Phosphatase as a Predictor for Hyperbilirubinemia in Full-term Neonates

Document Type : Original Article

Authors

1 Department of Pediatrics, Faculty of Medicine, Universitas Sumatera Utara Universitas Sumatera Utara Hospital, Medan, North Sumatera, Indonesia.

2 Department of Pediatrics, Faculty of Medicine, Universitas Sumatera Utara Universitas Sumatera Utara Hospital, Medan, North Sumatera, Indonesia

Abstract

Background: Neonatal hyperbilirubinemia is a common clinical condition among newborns that requires early detection and medical management to avoid bilirubin toxicity. This study aimed to investigate the role of cord blood alkaline phosphatase (ALP) levels as a predictor of hyperbilirubinemia in full-term neonates.
Methods: This cross-sectional study was conducted on full-term newborns within April-August 2019 in several hospitals in Medan, Indonesia. Cord blood ALP levels upon delivery and serum bilirubin levels on 72 h of life were measured.
Results: Out of 147 full-term neonates, the mean cord blood ALP levels and serum bilirubin levels were obtained at 166.3±45.1 IU/l and 9.6±2.3 mg/dl, respectively. There was a significant difference in mean cord blood ALP levels at serum bilirubin levels of >10 mg/dl and ≤10 mg/dl on 72 h of life (196.8±40.7 IU/l and 146.4±37.5 IU/l, respectively; P=0.001). A positive, moderate, and significant correlation was observed between cord blood ALP levels and serum bilirubin levels on 72 h of life (r=0.429; P=0.001). The cut-off value of 163.5 IU/l was associated with 84.7% sensitivity and 77.3% specificity for predicting hyperbilirubinemia in full-term neonates.
Conclusion: There was a positive correlation between cord blood ALP levels and serum bilirubin levels on 72 h of life. Therefore, cord blood ALP may be utilized as a predictor for hyperbilirubinemia in full-term neonates.
 
 

Keywords


  1. Shaughnessy EE, Goyal NK. Jaundice and hyperbilirubinemia in the newborn. In: Kleigman RM, St Geme III JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, Behrman RE, editors. Nelson textbook of pediatrics. 21st edition. Philadelphia: Elsevier. 2020; 4097-112.
  2. Ullah S, Rahman K, Hedayati M. Hyperbilirubinemia in neonates: types, causes, clinical examinations, preventive measures and treatments: a narrative review article. Iran J Public Health. 2016;45(5):558-68.
  3. Nahar Z, Shahidullah MD, Mannan A, Dey SK, Mitra U, Selimuzzaman SM, et al. The value of umbilical cord blood bilirubin measurement in predicting the development of significant hyperbilirubinemia in healthy newborn. Bangladesh j child health. 2009;33(2):50-4.
  4. Sgro M, Campbell D, Shah V. Incidence and causes of severe neonatal hyperbilirubinemia in Canada. Cmaj. 2006;175(6):587-90.
  5. Cloherty JP, Eichenwald EC, Stark AR. Manual of neonatal care. Lippincott Williams & Wilkins. 2008.
  6. Zeitoun AA, Elhagrasy HF, Abdelsatar DM. Predictive value of umbilical cord blood bilirubin in neonatal hyperbilirubinemia. Gaz Egypt Paediatr Assoc. 2013;61(1):23-30.
  7. Ahmadpour-Kacho M, Pasha YZ, Haghshenas M, Rad ZA, Firouzjahi A, Bijani A, et al. Cord blood alkaline phosphatase as an indicator of neonatal jaundice. Iran J Pediatr. 2015; 25(5):1-4.
  8. Tinnion RJ, Embleton ND. How to use… alkaline phosphatase in neonatology. Arch Dis Child Educ Pract Ed. 2012;97(4):157-63.
  9. Nalbantoglu A, Ovali F, Nalbantoglu B. Alkaline phosphatase as an early marker of hemolysis in newborns. Pediatr Int. 2011;53(6):936-8.
  10. Chou HC, Chien CT, Tsao PN, Hsieh WS, Chen CY, Chang MH, et al. Prediction of severe neonatal hyperbilirubinemia using cord blood hydrogen peroxide: a prospective study. Plos One. 2014;9(1):1-5.
  11. Okamoto T, Seo H, Mano H, Furuhashi M, Goto S, Tomoda Y, et aL. Expression of human placenta alkaline phosphatase in placenta during pregnancy. Placenta. 1990;11(4):319-27.
  12. Fenton TR, Lyon AW, Rose MS. Cord blood calcium, phosphate, magnesium, and alkaline phosphatase gestational age-specific reference intervals for preterm infants. BMC Pediatr. 2011;11(1):1-8.
  13. Al-Assal HM, Hablas HM, Afia ABE, Khedr MAA, El-kzaz. Utility of cord blood alkaline phosphatase enzyme as a predictor of significant neonatal jaundice in well term infants. N Y Sci J. 2017;10(4):70-4.
  14. Rohsiswatmo R, Amandito R. Hiperbilirubinemia pada neonatus >35 minggu di Indonesia: Pemeriksaan dan tatalaksana terkini. Sari Pediatri. 2018; 20(2):115-22.
  15. El-Amin DM, Ahmed YE, Hashim AM, Asmail AH. Evaluation of cord blood alkaline phosphatase levels as an indicator of neonatal jaundice. Al-Azhar Assiut Med J. 2020;18(2):112-7.
  16. Eid SR, Mohamed AG, Okda HT, Salam HM. Evaluation of cord blood alkaline phosphatase as a predictor of hyperbilirubinemia in Egyptian neonates. J Arab Soc Med Res.2020;15(1):11-17.