Pre-exchange Albumin Administration in Neonates with Hyperbilirubinemia: A Randomized Controlled Trial.

ABSTRACT

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 equivolume 0.9% saline in reducing post- exchange transfusion phototherapy duration or amount of bilirubin mass removed.