Pre exchange transfusion administration of albumin: an overlooked adjunct in the treatment of severe neonatal jaundice?

In this issue of Indian Pediatrics, Shahian and Moslehi(1) report that albumin given prior to exchange transfusion in jaundiced but healthy term newborns is associated with significantly lower post-procedure total serum unconjugated bilirubin levels (TSB) and a reduced need for further treatment. Unfortunately, the evidence presented does not support routine administration of albumin prior to exchange transfusion because the actual amounts of bilirubin removed by the procedure are not documented. The bilirubin removed by the procedure is readily obtained by measuring the volume and bilirubin content of the blood discarded during the procedure(2-4). Without these critical data, the study does not prove causation (i.e. that albumin administration was the cause of the difference in outcome).