Effect of albumin administration prior to exchange transfusion in term neonates with hyperbilirubinemia--a randomized controlled trial.

OBJECTIVE To determine the role of intravenous administration of human albumin prior to blood exchange in term neonates for reduction of total serum bilirubin (TSB). DESIGN Randomized controlled trial. SETTING Neonatal Unit of Nemazee Hospital, affiliated with Shiraz University of Medical Sciences, southern Iran. PATIENTS Fifty out-born term neonates with gestation age <37 weeks, birth weight <2500 g, otherwise healthy with TSB > or =25 mg/dL requiring blood exchange due to intensive phototherapy failure. INTERVENTION Intervention group (n=25) received intravenous human albumin 20% (1 g/kg) one hour before exchange while the control group (n=25) underwent a blood exchange. OUTCOME MEASURES TSB level at 6 and 12 hours post-exchange, total duration of phototherapy, need for a second exchange transfusion and adverse effects. RESULTS The mean TSB level in albumin-treated group was significantly lower than that in the control group at 6 and 12 hours post-exchange (P<0.001). Mean duration of phototherapy was significantly reduced in the albumin-treated group, compared to that in the control group (8.6+/-2.4 vs. 25+/-8.2 hours) (P<0.001). None of the neonates in albumin-treated group needed exchange transfusion again and no side effects were observed. CONCLUSION Infusion of 20% albumin (1 g/kg) one hour prior to blood exchange can significantly reduce the post-exchange total serum bilirubin and duration of phototherapy.