Pre-exchange 5% Albumin Infusion in Low Birth Weight Neonates with Intensive Phototherapy Failure--A Randomized Controlled Trial

Abstract

To evaluate the role of 5% albumin infusion before exchange transfusion in reducing post-exchange unconjugated serum bilirubin (UCB) levels in low birth weight (LBW) neonates with intensive phototherapy failure. In a placebo-controlled Randomized Controlled Trial, 42 healthy LBW (birth weight between 1000 and 2499 g and gestational age ≥ 32 weeks) neonates were randomly allocated into intervention and control groups. Post-exchange UCB at 6 and 12 h were compared in the two groups along with the duration of post-exchange phototherapy, repeat-exchange requirement, adverse effects of albumin and hospital stay. The intervention group (n = 21) with mean birth weight 1619 ± 324 g, gestational age 34.5 ± 1.65 weeks, peak UCB 19 ± 3.85 mg dl(-1), was demographically comparable with the control group (n = 21) (1660 ± 320 g, 34 ± 1.6 weeks, 19.4 ± 3.59 mg dl(-1), respectively). Significant reduction in the post-exchange UCB (10.55 ± 1.53 mg dl(-1) at 6 h; 5.86 ± 1.21 mg dl(-1) at 12 h in albumin group; 15.26 ± 1.78 mg dl(-1) at 6 h; 11.69 ± 1.52 mg dl(-1) at 12 h in control group) and phototherapy duration (23.8 ± 3.2 h vs. 40.3 ± 7.2 h) was observed in the intervention group (p < 0.0001). Repeat exchange requirement was reduced by 86% (RR = 0.14; 95%CI: 0.19-1.06). Mean duration of hospital stay was significantly lower (10.1 ± 5.8 days vs. 12.4 ± 6.6 days) (p = 0.021). No albumin transfusion-related complications were observed.