Pre exchange albumin administration in neonates with hyperbilirubinemia: a randomized controlled trial
Indian Pediatrics. 2015;52((9)):763-7.
OBJECTIVE To evaluate the efficacy of pre-exchange transfusion albumin priming in neonates with non-hemolytic hyperbilirubinemia. DESIGN Single center, randomized controlled trial. SETTING Level III Neonatal unit. PARTICIPANTS Fifty healthy term and late preterm neonates with non-hemolytic hyperbilirubinemia requiring exchange transfusion. INTERVENTIONS 5 mL/kg of either 20% human albumin (n=23) or 0.9% saline (n=27) infusion one hour prior to exchange transfusion. MAIN OUTCOME MEASURE Post-exchange transfusion phototherapy duration. RESULTS The post-exchange transfusion phototherapy duration was not different between albumin and saline groups [Median (IQR): 29 (24-48) h vs. 33 (24-43) h; P=0.76]. The total amount of bilirubin removed during exchange transfusion was also similar [Median (IQR): 34 (28-46) mg vs. 33 (27-38) mg; P=0.46]. Serial changes in total serum bilirubin following exchange transfusion and need for repeat exchange transfusion were comparable between the groups. CONCLUSIONS In healthy late preterm and term neonates with non-hemolytic hyperbilirubinemia, priming with 1 g/kg of 20% albumin prior to exchange transfusion is not superior to equi-volume 0.9% saline in reducing post- exchange transfusion phototherapy duration or amount of bilirubin mass removed.
Variance in albumin loading in exchange transfusions
Journal of Pediatrics. 1976;88((4, Pt 1):):609-13.
To assess the rationale of albumin priming prior to exchange transfusions, 42 hyperbilirubinemic infants who required exchange transfusions were randomly assigned to one of two groups. Group I consisted of 15 infants who were given intravenously 1 gm/kg of salt-poor human serum albumin one hour before the exchanges. Group II, which consisted of 27 infants, received simple exchanges. No statistical differences were found in variations in reserve albumin-binding capacity, bilirubin, albumin, or red cell bilirubin at pre and one-hour post albumin infusion in the primed infants. The amount of bilirubin removed per kilogram is directly correlated to plasma bilirubin concentration (r=0.87). No significant difference in efficiency on bilirubin removal was seen between the two groups. Beneficial effects of albumin therapy was apparent only in those infants with low RABC as determined by the sephadex gel filtration technique.