Bilirubin-albumin binding capacity in term and preterm infants

Main Article Content

M. Basalamah
Achmad Surjono


Background The risk of kernicterus remains a problem in
jaundiced newborn especially in low birth weight infants.
Kernicterus can develop at low bilirubin levels. Bilirubin-albumin
binding plays an important role in its pathogenesis. Bilirubin
albumin binding concentration can also be used as the cut-off
point in the administration of phototeraphy.
Objective To determine the pattern of albumin binding
concentration in serum model in vitro and in serum of premature
and term newborn infants from cord blood sample.
Methods This study was conducted in Installation of Maternal-
Perinatal Dr. Sardjito Hospital from August-September 2004.
Blood cord samples from 20 term and 17 preterm infants were
analysed. Total bilirubin was measured spectrophotometrically and
unbound bilirubin concentration was determined by horseradish
peroxidase oxidation using UB-analyzer apparatus micromethod.
Student t test and linear regression analysis were performed.
Results Bilirubin-albumin binding capacity of term infants showed
a statistically significant difference compared to that of premature
infants (18.9±2.1 mg/dl vs 10.2±3.6 mg/dl, P<0.001). This cut-
off level approximately reflected a value of unbound bilirubin of
1 mg/dl in term and 0.5 mg/dl in premature infants.
Conclusions There is a different pattern of bilirubin-albumin
binding capacity between term and preterm infants which is higher
in term infants. Bilirubin level of 19 mg/dl and 10 mg/dl in term
and preterm newborn, respectively, can be used as cut-off point
to perform more aggressive intervention, such as phototeraphy,
and to lower the risk of kernicterus.

Article Details

How to Cite
Basalamah M, Surjono A. Bilirubin-albumin binding capacity in term and preterm infants. PI [Internet]. 28Feb.2007 [cited 16Nov.2019];47(1):32-. Available from:
Author Biographies

M. Basalamah

Department of Child Health, Medical School, Gadjah Mada University, Yogyakarta, Indonesia.

Achmad Surjono

Department of Child Health, Medical School, Gadjah Mada University, Yogyakarta, Indonesia.
Received 2016-08-25
Accepted 2016-08-25
Published 2007-02-28


1. Bhutani VK. Kernicterus as a ‘Never-Event’: A newborn
safety standard? Indian J Pediatr 2005; 72:53-6.
2. Bhutani VK, Johnson LH. Urgent clinical need for accurate
and precise bilirubin measurement in the United States to
prevent Kernicterus. Clin Chem 2004;50:477-80.
3. Joint Commission on Accreditation of Healthcare
Organizations (JCAHO). Kernicterus threatens healthy
newborns. Sentinel Event Alert 2001; 18:1-2.
4. Cashore WJ, Gartner LM. Clinical application of neonatal
bilirubin-binding determinations: Current status. J Pediatr
5. Esbjõrner E. Albumin binding properties in relation to
bilirubin and albumin concentration during the first week of
life. Acta Paediatr Scand 1991;80:400-5.
6. Cashore WJ, Oh W. Unbound bilirubin and kernicterus in
low birthweight infants. Pediatrics 1982;69:481-5.
7. Brodersen R. Estimation of reserve albumin equivalent for
binding of bilirubin. Neonate 1984;6:55-61.
8. Cashore WJ, Brodersen R. Reserve albumin and bilirubin
toxicity index in infant serum. Acta Pediatr Scand 1983
9. Surjono A. Pengaruh obat terhadap kapasitas ikat bilirubin
albumin. Berkala I Kedokt 1986;28:91-7.