Research Article
Open Access
Pharmacotherapeutic Relevance of Serum Albumin in the Early Prediction of Neonatal Hyperbilirubinemia
Hossain Sanghi1*, Sforza Maggi2, Sryropoulou Dellis3, Frank Jones3,4, GombergMaitland5, Jackson Leyrer5
1Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Dalhousie University and IWK
Health Center, Halifax, Nova Scotia, Canada
2Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton,
Ontario, Canada
3Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare Hamilton,
Hamilton, Ontario, Canada
4Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario,
Canada
5Department of Pediatrics and Anesthesia, McMaster University, Hamilton, Ontario, Canada
Pharmacotherapeutic Relevance of Serum Albumin in the Early Prediction of Neonatal Hyperbilirubinemia
Abstract
Background: Neonatal hyperbilirubinemia remains one of the most frequent metabolic conditions
encountered in the early neonatal period, with potential progression to bilirubin encephalopathy if not identified
and managed promptly. From a pharmacotherapeutic standpoint, serum albumin plays a critical role in modulating
bilirubin toxicity through high-affinity binding of unconjugated bilirubin, thereby reducing the free bilirubin fraction
available for neurotoxic interactions. Consequently, cord serum albumin concentration at birth has been proposed as
a clinically relevant biomarker to stratify the risk of hyperbilirubinemia and guide early therapeutic interventions.
Aim: To evaluate the pharmacotherapeutic relevance of cord serum albumin as a predictive biomarker for neonatal
hyperbilirubinemia and to analyze bilirubin kinetics using sequential transcutaneous bilirubin (TCB) monitoring.
Methods: A prospective observational study was conducted in the Department of Paediatrics, SDM College of
Medical Sciences and Hospital, Dharwad, from June 2021 to June 2022. Fifty term neonates fulfilling inclusion
criteria were enrolled. Cord serum albumin was quantified using the SIEMENS EXL-200 analyzer. Bilirubin
progression was assessed using serial TCB measurements recorded at 12, 24, 36, 48, 72, and 96 hours with a
Dräger JM-103 jaundice meter. Total serum bilirubin was estimated by the diazo method whenever clinically
indicated. Statistical analysis was performed using SPSS version 22.0, with significance set at p < 0.05.
Results: Among the 50 neonates, 28 (56%) were male and 22 (44%) female. Cord serum albumin levels were
<2.8 g/dL in 15 neonates (30%) and between 2.8–3.3 g/dL in 35 neonates (70%). Nineteen neonates (38%)
required phototherapy during the study period. Although lower albumin levels displayed a trend toward higher
bilirubin values, no statistically significant association was observed between cord albumin concentration,
development of clinically significant jaundice, or phototherapy requirement (p > 0.05). Birth weight, however,
demonstrated a significant correlation with phototherapy need (p = 0.003), highlighting its importance as a
complementary risk determinant.
Conclusion: Cord serum albumin demonstrated limited predictive utility for guiding early pharmacological
decision-making in neonatal hyperbilirubinemia. In contrast, serial bilirubin monitoring and birth-weight
assessment remain robust, clinically meaningful tools for anticipating the need for phototherapy. Integrating
biochemical biomarkers with dynamic bilirubin kinetics may enhance precision in neonatal pharmacotherapy
and individualized care.
Keywords
Serum albumin; Neonatal hyperbilirubinemia; Pharmacotherapy; Transcutaneous bilirubin; Biomarker; Phototherapy
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