The Role of Umbilical Cord Alpha Fetoprotein as a Screening Tool for Neonatal Hyperbilirubinemia

Our aim was to test whether alpha fetoprotein (AFP) might serve as a marker of hepatic immaturity sufficient to predict an increased risk for neonatal hyperbilirubinemia (NHB) in term babies. We checked umbilical cord AFP (UC AFP) levels in 174 healthy full-term infants (male/female ratio 1.26:1) at birth. Bilirubin levels were measured upon discharge from the nursery on day 3 of life (mean, 57 ± 10 hours of life). Mean UC AFP was 60.2 ± 45.9 mg/L. UC AFP levels were linearly correlated with subsequent bilirubin levels, and significantly higher bilirubin levels were found in neonates whose UC AFP levels were 100 mg/L or more. Although statistically significant correlation between UC AFP and subsequent NHB exists, UC AFP cannot currently be recommended for use in clinical practice because of its inability to serve as a screening tool for significant NHB in the individual newborn.

KEYWORDS

Neonatal hyperbilirubinemia - alpha fetoprotein - umbilical cord

REFERENCES

• 1 Kivlahan C, James E J. The natural history of neonatal jaundice.  Pediatrics. 1984;  74 364-370
• 2 Maisels M J, Gifford K, Antle C E, Leib G R. Jaundice in the healthy newborn infant: a new approach to an old problem.  Pediatrics. 1988;  81 505-511
• 3 Maisels M J, Jaundice. In: Avery GB, Fletcher MA, MacDonald MG Neonatology, Pathophysiology and Management of the Newborn. Philadelphia; Lippincott Williams & Wilkins 1999: 765-819
• 4 Dennery P A, Seidman D S, Stevenson D K. Neonatal hyperbilirubinemia.  N Engl J Med. 2001;  344 581-590
• 5 Bergstrand C G. Alphafetoprotein in paediatrics.  Acta Paediatr Scand. 1986;  75 1-9
• 6 Goldstein A I, Farrell R C. Physiologic jaundice of the newborn. Relation to maternal serum and amniotic fluid alpha-fetoprotein.  Obstet Gynecol. 1978;  51 315-317
• 7 Malan C, Donald P R, Odendaal H J, Shanley B C. Alpha 1-fetoproten in neonatal jaundice.  S Afr Med J. 1978;  54 281-283
• 8 Ikonen R S, Lindgren J, Niemi E, Sorto A E, Seppala M, Ruoslahti E. Alpha fetoprotein levels in neonatal hyperbilirubinaemia.  Acta Paediatr Scand. 1980;  69 59-63
• 9 Tan K L, Loganath A, Roy A C, Goh H H, Karim S M, Ratnam S S. Cord plasma alpha-fetoprotein values and neonatal jaundice.  Pediatrics. 1984;  74 1065-1068
• 10 Huang C S, Hung K L, Chen F Z. Cord blood alpha-fetoprotein, gamma-glutamyl transpeptidase and neonatal jaundice.  Taiwan Yi Xue Hui Za Zhi. 1987;  86 433-437
• 11 Montagna O, Mautone A, Altomare M et al.. Transferrin/alpha-fetoprotein ratio as a predictive index in hyperbilirubinemia.  Minerva Pediatr. 1987;  39 361-363
• 12 Hodr R, Stroufova A, Kepertova M, Ondrackova Z, Skutilova J. Alpha-fetoprotein in umbilical cord blood and hyperbilirubinemia in normal neonates.  Cesk Pediatr. 1990;  45 390-393
• 13 Lee P I, Chang M H, Chen D S, Lee C Y. Serum alpha-fetoprotein levels in normal infants: a reappraisal of regression analysis and sex difference.  J Pediatr Gastroenterol Nutr. 1989;  8 19-25
• 14 Tsuchida Y, Endo Y, Saito S, Kaneko M, Shiraki K, Ohmi K. Evaluation of alpha-fetoprotein in early infancy.  J Pediatr Surg. 1978;  13 155-162
• 15 Bhutani V K, Johnson L, Sivieri E M. Predictive ability of a predischarge hour-specific serum bilirubin for subsequent significant hyperbilirubinemia in healthy term and near-term newborns.  Pediatrics. 1999;  103 6-14