P2.H160: Incidence and risk factors of low serum albumin level in neonates evaluated for jaundice

Background: Serum albumin < 3.0 g/dL is one of the hyperbilirubinemia neurotoxicity risk factors for jaundice infants as defined by The American Academy of Pediatrics clinical practice guideline for the management of hyperbilirubinemia in newborn infant ≥ 35 weeks of gestation. However, routine measurement of serum albumin for all neonates was not recommended, and data on the incidence and risk factors of low serum albumin levels in neonates are limited. This study aims to assess the incidence and risk factors of low serum albumin level in neonates evaluated for jaundice.

Methods: A retrospective chart review was conducted on inborn infants ≥ 35 weeks gestation, evaluated for early neonatal jaundice across three hospitals affiliated with the Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand from January 1st to December 31st, 2023. During this period, serum albumin levels were routinely assessed as part of jaundice evaluation. Infant’s demographics, hyperbilirubinemia neurotoxicity risk factors, serum albumin, and maternal clinical characteristics were collected. Potential risk factors of hypoalbuminemia were compared between infants with serum albumin < 3.0 g/dL (hypoalbuminemia group) and infants with serum albumin ≥ 3.0 g/dL (normal albumin group). A univariate logistic regression was performed to investigate the association between each variable and infant hypoalbuminemia. Factors demonstrating an association with p-value < 0.1 in univariate logistic regression were entered into the multivariate logistic regression model.

Results: During the study period, 902 inborn infants from three centers were evaluated for jaundice, 229 infants (25.4%) were categorized into the hypoalbuminemia group, and 673 infants (74.7%) were categorized into the normal albumin group. The infants in the hypoalbuminemia group had lower average gestational age, lower Apgar score at 1 and 5 min, higher number of male sex, higher number of infants with clinical instability or sepsis, and were younger at the time of testing than the normal albumin group. The average maternal age of infants in the hypoalbuminemia group was higher than those of the normal albumin group. In a univariate logistic regression model, male sex, clinical instability or sepsis, lower gestational age, and lower Apgar score at 1 and 5 minutes were associated with an increased risk of hypoalbuminemia with p-value < 0.1. However, in a multivariate logistic regression model that included the factors above, only clinical instability or sepsis, male sex, and lower gestational age increased the risk of hypoalbuminemia, with p-value < 0.05.

Conclusion: 25% of infants assessed for jaundice have serum albumin below 3.0 g/dL. Clinical instability or sepsis, male sex, and lower gestational age were risk factors for those newborns.