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

Sir,We have read with great interest the recent article by Costa et al. [2]. However, we have some comments on it.The authors reported a case of subcapsular hepatic haematoma associated with a high level of alpha-foetoprotein (AFP), for which diagnosis was made with conservative management, following up with the reduction in size at ultrasound examination and the reduction of the level of AFP. AFP levels were reported to be high (35,000 ng/mL vs a normal value of AFP at their hospital <13 ng/mL). A consistent decrease of AFP level was documented: AFP falls to 6,700 ng/mL three weeks later and was in the normal range after two months. However, we think that the AFP level of 35,000 ng/ml reported by Costa et al.[2] might be within the normal range for the neonatal period.In the study of Bader et al.[1], serum AFP concentrations were measured and characterised in 260 term and near-term newborns. Due to the wide range of AFP concentrations, it is useful to relate to a reference interval for AFP concentrations at birth that was 15,700-146,500 ng/ml, with a median value of 48,300 ng/ml. However, mean AFP concentrations at birth that were 61,600±44,800 ng/ml are less informative, due to the large standard deviation. At 60±24 h of life, AFP concentrations dropped to 9,700-111,900 ng/ml, with a median of 34,200 ng/ml. Riskin et al.[3] checked the umbilical cord AFP levels in 174 healthy full-term infants at birth. The mean umbilical cord AFP was found to be 60,200±45,900 ng/ml in their study. Likewise, the mean umbilical cord AFP was less informative due to the large standard deviation.Costa et al.[2] stated that a normal value of AFP at their hospital was <13 ng/mL [2]. This normal value might be acceptable for the childhood and adulthood period but not for the neonatal period. However, there is a wide variation in AFP concentrations in newborn infants [1,3]. Due to the wide range of AFP concentrations in healthy newborns, special precaution is required in interpreting high levels of AFP when liver diseases or congenital tumours are present in the early neonatal period. In these circumstances, the kinetics of the decline in AFP concentrations is more important than an absolute value.In conclusion, the AFP level of 35,000 ng/ml reported in the recent article by Costa et al.[2] might be within the normal range for the neonatal period. References

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Alpha-foetoprotein levels in the neonatal period

Köklü

Güneş

Akçakuş

et al. 2007

Eur J Pediatr

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Alpha-fetoprotein in the early neonatal period—a large study and review of the literature

Bader

Riskin

Vafsi

et al. 2004

Clinica Chimica Acta

127

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Yenidoğan ünitesine sarılık nedeniyle yatırılan bebeklerin klinik ve laboratuar özellikleri ve risk faktörlerinin araştırılması

Yorulmaz¹,

Yücel²,

Sert³

et al. 2018

Journal of Contemporary Medicine

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Yenidoğan ünitesine sarılık nedeniyle yatırılan bebeklerin klinik ve laboratuvar özellikleri ve risk faktörlerinin araştırılması Investigation of risk factors and clinical and laboratory characteristics of infants hospitalized in neonatal unit due to jaundice Amaç: Bu çalışmada hiperbilirübinemi nedeni ile yatırılan sağlıklı term bebeklerin klinik ve laboratuar özellikleri, indirekt hiperbilirübinemi açısından günümüz risk faktörlerinin belirlenmesi ve bu sorunun bölgemizdeki durumunun gözden geçirilmesi amaçlandı. Gereç ve Yöntem: Bu çalışma; Ocak 2014-Ocak 2016 yılları arasında, Konya Beyhekim Devlet Hastanesi Çocuk Sağlığı ve Hastalıkları Kliniği, Yenidoğan Yoğun Bakım Ünitesine tedavi amacıyla yatırılmış olan 240 indirekt hiperbilirubinemili yenidoğan bebek ile hasta kayıtlarından alınan bilgiler ışığında geriye dönük olarak yapıldı. Hasta dosyasından; cinsiyet, doğum tartısı, hastaneye yatırıldığındaki tartı, sarılığın başlangıç günü, kaçıncı gün yatırıldığı, etyolojik etmenler ile ilgili bilgiler geriye dönük olarak toplandı. Bulgular: Değerlendirmeye alınan 240 hastanın 132'si (%55.0) erkek, 108'i (%45.0) kız idi. Hastaların ortalama doğum ağırlıkları 3046.94±422.71 gr olup, 29 (%12.08) hasta 2500 gramın altında idi. Yatışta vücut ağırlıkları ortalama 3094.25±471.02 gr idi. Olguların %7.5'i geç preterm bebeklerdi. Hastalara tanı konulduğu yaş 4.95±2.29 gün idi. Sonuç: İndirekt hiperbilirubinemi, gelişmiş yöntemler ve tedavilere rağmen günümüz yenidoğan acil yaklaşım pratiğinde halen güncelliğini ve önemini korumaktadır. Anahtar Sözcükler: Hiperbilirubinemi; risk etmenleri; yenidoğan. Introduction: In this study, we aimed to determine the clinical and laboratory characteristics of healthy term babies admitted to our hospital with hyperbilirubinemia, today's risk factors in terms of indirect hyperbilirubinemia and, to review the situation of this problem in our region. Methods: In this study, medical records of 240 newborn infants admitted to Neonatal Intensive Care Unit, Children's Health and Diseases Clinic, Konya Beyhekim State Hospital, with indirect hyperbilirubinemia, and hospitalized for treatment between January 2014 and January 2016, were analyzed, retrospectively. Information regarding gender, birth weight, weight at admission, date of onset of jaundice, which day the patient hospitalized, etiologic factors were collected from patient's medical records, retrospectively. Results: Of the 240 patients who were evaluated, 132 (55.0%) were male and 108 (45.0%) were female. The mean birth weights of the patients were 3046.94±22.71 g and 29 (12.08%) patients were below 2500 g. The average body weight of patients at admission was 3094.25±471.02 gr. Seven percent of the cases were late preterm infants. The ages at diagnosis was 4.95±2.29 days. Discussion and Conclusion: Indirect hyperbilirubinemia, despite advanced methods and treatments, is still an updated and important problem in today's neonatal emergency practice.

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

Cited by 5 publications

References 4 publications

Alpha-foetoprotein levels in the neonatal period

Alpha-foetoprotein levels in the neonatal period

Alpha-fetoprotein in the early neonatal period—a large study and review of the literature

Yenidoğan ünitesine sarılık nedeniyle yatırılan bebeklerin klinik ve laboratuar özellikleri ve risk faktörlerinin araştırılması

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