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Postnatal changes in the ability of plasma albumin to bind bilirubin
Insights
In healthy infants, the albumin fraction binding bilirubin is low initially but increases significantly by 60 hours after birth. This binding capacity correlates with infant maturity, impacting bilirubin levels.
Area of Science:
- Neonatal Medicine
- Biochemistry
- Pediatrics
Background:
- Unconjugated bilirubin can cause neonatal jaundice.
- Albumin plays a crucial role in binding and transporting bilirubin in the blood.
- Understanding albumin's binding capacity is vital for managing neonatal hyperbilirubinemia.
Purpose of the Study:
- To determine the plasma concentrations of total albumin, unconjugated bilirubin, and reserve albumin in healthy infants up to eight days old.
- To investigate the changes in the bilirubin-binding albumin fraction over the first week of life.
- To assess the relationship between the bilirubin-binding albumin fraction and infant maturity (birth weight, gestational age).
Main Methods:
- Plasma concentrations of total albumin, unconjugated bilirubin, and reserve albumin were measured in 407 healthy infants.
- Reserve albumin was quantified using monoacetyldiaminodiphenyl-sulfone (MADDS) as a bilirubin surrogate.
- The bilirubin-binding albumin fraction was calculated as (bilirubin + reserve albumin) / total albumin.
Main Results:
- The bilirubin-binding albumin fraction was low (average 0.36) and stable during the first 24 hours of life, irrespective of infant maturity.
- From approximately 24 hours, the fraction increased, reaching a plateau around 60 hours after birth.
- Post-60 hours, the binding fraction correlated positively with birth weight and gestational age, reaching an average of 0.58 in mature infants.
Conclusions:
- The bilirubin-binding capacity of albumin undergoes significant development in the first 60 hours of neonatal life.
- Infant maturity, indicated by birth weight and gestational age, influences the final level of bilirubin-binding albumin.
- These findings contribute to understanding bilirubin metabolism and binding dynamics in newborns.
Abstract:
The plasma concentrations of total albumin, unconjugated bilirubin and reserve albumin for bilirubin binding were determined in 407 healthy infants of various age up to eight days. The albumin reserve was measured using monoacetyldiaminodiphenyl-sulfone (MADDS) as a deputy ligand for bilirubin. The fraction of albumin capable of binding bilirubin was calculated as the sum of the concentrations of bilirubin and reserve albumin, divided by the total albumin concentration. Our data showed that this fraction was low (average 0.36) and did not change during the first 24 hours of life, and in this period it was independent of the maturity of the infant, as expressed by its birth weight or gestational age. From about 24 hours of life, the fraction began to increase. This increase came to an end about 60 hours after birth, and no further changes were seen during the following five days. The level of the bilirubin-binding fraction reached 60 hours after birth was related to the maturity of the infant: It increased with increasing birth weight up to 3000 g and with increasing gestational age up to 275 days, when on an average it was about 0.58. The fraction of binding albumin was independent of the sex.