Serum Albumin Assessment in Neonatal Jaundice: Impact on Phototherapy Decision-Making

Abstract

Objective: The objective of this study was to investigate the impact of serum albumin assessment on early neonatal jaundice treatment decisions.

Patients and methods: A retrospective review of medical records was conducted for infants of 35 weeks' gestation or more, evaluated for early neonatal jaundice in 3 hospitals in Thailand from January 1 to December 31, 2023. Per hospital protocol, serum albumin levels were routinely measured during the jaundice evaluation. Infant demographics; serum albumin; total serum bilirubin (TSB); laboratory work-up for jaundice; hyperbilirubinemia neurotoxicity risk factors; hour-specific, risk-based phototherapy threshold; and rates of phototherapy treatment were evaluated.

Results: Out of 935 infants evaluated for hyperbilirubinemia, 250 infants (26.7%) had serum albumin levels less than 3.0 g/dL. Among 121 infants who received phototherapy at TSB levels meeting the guideline threshold, 49 infants had serum albumin less than 3.0 g/dL as one of the neurotoxicity risk factors. However, the decision for phototherapy would not have changed when other neurotoxicity risk factors were present, when TSB at the time of initiation of phototherapy was higher than the threshold without neurotoxicity risk factors, or when TSB at the time of cessation of phototherapy was lower than the threshold with neurotoxicity risk factors. As a result, the identification of serum albumin less than 3.0 g/dL affected phototherapy treatment decision in 16 infants (affected initiation in 13, cessation in 1, and both the initiation and cessation in 2) or 1.7% of all infants evaluated for jaundice.

Conclusions: Serum albumin levels less than 3.0 g/dL are common, affecting 1 in 4 infants assessed for jaundice. However, this has minimal impact on phototherapy decisions.