Low Reserve Albumin for Binding of Bilirubin in Neonates With Deficiency of Bilirubin Excretion and Bronze Baby Syndrome

Abstract

The plasma reserve albumin concentration for binding of bilirubin was found to be low in four newborn infants with deficiency of bilirubin excretion, of whom two had the bronze baby syndrome. Thus, the risk of bilirubin encephalopathy was increased. Also the ratio of binding fraction of albumin, i.e. unconjugated bilirubin plus reserve albumin, to total albumin was low. Possible causes of the low reserve albumin concentration and the ratio are discussed.

Treatment of jaundice in low birthweight infants

“…50 52 Except for these case reports, there are no other reports of significant complications in infants who develop the bronze baby syndrome, although impaired binding of bilirubin to albumin has been detected in three infants with this syndrome 53 54 and in infants with cholestasis. 53 If there is a need for phototherapy, the presence of direct hyperbilirubinaemia should not be considered a contraindication to its use, particularly in the sick newborn, and, as a rule, the direct serum bilirubin level should not be subtracted from the total bilirubin concentration when decisions are made about initiating phototherapy or an exchange transfusion (tables 1-3). In infants who develop the bronze baby syndrome, exchange transfusion should be considered if phototherapy does not lower TSB.…”

An approach to the management of hyperbilirubinemia in the preterm infant less than 35 weeks of gestation

“…Kernicterus has been described in term infants with TSB levels >20 mg dl À1 (314 mmol l À1 ) but in whom, because of significant elevations in direct bilirubin levels, the indirect bilirubin levels were well below 20 mg dl À1 . 49,50 There is some evidence that elevated direct bilirubin levels can decrease the infant's albumin-binding capacity 51 and it has been suggested, but not confirmed, that infants with the bronze baby syndrome might be at an increased risk of developing bilirubin encephalopathy. 51,52 As a general rule, when considering the use of phototherapy or exchange transfusion, the direct-reacting (or conjugated) bilirubin level should not be subtracted from the total.…”

Reduced Albumin Binding of MADDS–a Measure for Bilirubin Binding–in Sick Children

“…The reserve albumin concentration for binding of MADDS in plasma is reduced in healthy, newborn infants compared with that in adults (5,6). The concentration was further reduced in a group of sick, newborn infants including infants with sepsis (6); the lowest concentration seemed to occur in neonates with hepatic diseases (7). By means of the Sephadex method the bilirubin binding ability of albumin was found to reach an adult level at 5 months of age (8).…”

“…The aim of the present study was to investigate whether a reduction in the reserve albumin concentration for binding of MADDS can also be seen in sick children after 5 months of age, where the bilirubin binding ability of albumin normally has reached adult level. On the basis of the mentioned examinations of sick neonates (6,7) we have chosen to investigate the reserve albumin concentration for binding of MADDS in children with mild infections, severe bacterial infections, acute viral hepatitis, chronic hepatic diseases, and uraemia. Children with uraemia were included, since in this condition a number of substances are retained in the body.…”