Albumin in management of neonatal hyperbilirubinaemia

Abstract

The effect of albumin priming on the plasma volume, intravascular bilirubin, and HBABA-binding capacity during the subsequent 2 to 4 1/2 hours before exchange transfusion was studied in 7 jaundiced neonates with no haemolytic disease. After priming with albumin at a dose of 1· 75 g/kg body weight as a 10% solution, there was a marked increase in plasma volume as well as total intravascular bilirubin and HBABA-binding capacity. However, the serum bilirubin concentration fluctuated only very slightly, largely because of the dilution effect of the expanded plasma volume. Both albumin and bilirubin gradually diffused out of the intravascular compartment again, but at the end of the observation period there was still a net gain of both. In another 20 neonates, the efficiency of exchange transfusion in removing bilirubin was compared. The efficiency was decreased by early albumin priming and enhanced by enriching the donor's blood with albumin. It is concluded that albumin offers immediate and short-term protection against bilirubin toxicity, and albumin-priming should be useful in situations where the babies are admitted with high bilirubin levels and blood is not immediately available for exchange transfusion. Because of its effect on the plasma volume, albumin is not recommended for babies who are already hypervolaemic. If albumin is used to increase the efficiency of exchange transfusion, it should be given together with donor's blood or shortly before the procedure.