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

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.