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.