Hypoalbuminemia following Abdominal Surgery Leads to High Serum Unbound Bilirubin Concentrations in Newborns Soon after Birth

Abstract

Background: The serum concentration of unbound bilirubin (UB), which is bilirubin not bound to albumin (Alb), is a better index than total bilirubin concentration (TB) for identifying infants at risk for developing bilirubin neurotoxicity. The degree to which the hypoalbuminemia following abdominal surgery in jaundiced newborns affects bilirubin binding is unknown. Objective: To determine whether lower Alb occurring in newborns undergoing abdominal surgery shortly after birth results in significantly higher UB in serum versus nonsurgical patients at comparable serum TB. Methods: A matched case-control study was conducted with term and late-preterm newborns. The surgery group included 15 newborns who underwent abdominal operation within 3 days after birth. Clinical and laboratory data (serum UB, TB, and Alb concentrations, UB/TB ratio, and binding constant) in the surgery group were collected and compared with those of 30 control newborns who did not undergo abdominal surgery (control group). Results: Serum UB and the UB/TB ratio in the surgery group were significantly higher than those in the control group (p < 0.02, p < 0.001, respectively), whereas there were no significant differences in serum TB and binding constant between the groups. Serum Alb concentrations in the surgery group were significantly lower than those in the control group (p < 0.001). When pre- and postoperative serum Alb concentrations were compared, there was a significant decrease from 3.4 to 2.7 g/dl (p < 0.001). Conclusions: Our study suggests that hypoalbuminemia following abdominal surgery causes a higher serum UB at comparable serum TB in newborns.

Unbound Free Fatty Acids from Preterm Infants Treated with Intralipid Decouples Unbound from Total Bilirubin Potentially Making Phototherapy Ineffective

“…5 would be reduced only to 24 and 45 n M , levels that may remain toxic for these extremely premature infants [16]. FFA from sepsis would further increase FFA u levels, and B f levels would be increased further by low albumin [17,18]. Thus, in the presence of Intralipid, phototherapy alone may not be effective for prevention of acute bilirubin encephalopathy.…”

Serum unbound bilirubin as a predictor for clinical kernicterus in extremely low birth weight infants at a late age in the neonatal intensive care unit

“…Serum TB and UB levels were measured at the same time using a Food and Drug Administration-approved analyzer (UB Analyzer; Arrows Co., Ltd, Osaka, Japan) by spectrophotometry and the glucose oxidase-peroxidase method, respectively, as previously described [8,[13][14][15][16]. Serum UB levels were measured using the single peroxidase concentration method, as recommended by the manufacturer, because this has a higher precision than the two peroxidase concentration method [13].…”

Severe Neonatal Hyperbilirubinemia and Kernicterus: Are These Still Problems in the Third Millennium?

“…Unbound bilirubin values may be used in the future to determine the risk of an individual baby developing kernicterus and to decide on therapeutic procedures. Of practical implication, suggesting the need for cautious evaluation of hyperbilirubinemic neonates who have undergone abdominal surgery, may be the recent finding of hypoalbuminemia associated with increased unbound bilirubin, the latter both individually and relative to total serum bilirubin, in neonates who had undergone abdominal surgery compared with controls in whom surgery had not been performed [38] .…”