Cord Blood Biomarkers for Predicting Significant Hyperbilirubinemia in Apparently Healthy Term Neonates: A Prospective Observational Study

Abstract Objectives: To evaluate cord blood albumin, bilirubin, bilirubin-to-albumin ratio, and alkaline phosphatase as early predictors of significant hyperbilirubinemia in apparently healthy term neonates. Methods: In this prospective observational study, 250 apparently healthy term neonates were enrolled consecutively. Cord blood bilirubin, albumin, and alkaline phosphatase were measured at birth, and the bilirubin-to-albumin ratio was calculated. Total serum bilirubin was measured at 72–96 h. Significant hyperbilirubinemia was defined as total serum bilirubin ≥17 mg/dL. Predictive performance was evaluated using receiver operating characteristic curves. Results: Significant hyperbilirubinemia developed in 38 (15.2%) neonates. Affected neonates had lower cord albumin and higher cord bilirubin, bilirubin-to-albumin ratio, and alkaline phosphatase (all P < 0.001). The respective areas under the curve were 0.909, 0.983, 0.984, and 0.906. Conclusions: Cord blood bilirubin and the bilirubin-to-albumin ratio showed the strongest predictive performance. These markers may help identify apparently healthy term neonates who need closer surveillance. External validation of the study-derived cut-offs is required. Keywords: Bilirubin-albumin ratio; Cord blood; Neonatal hyperbilirubinemia; Screening; Term neonates