Albumin in Management of Neonatal Hyperbilirubinaemia

Abstract

1972). Archives of Disease in Childhood, 47, 250. Albumin in management of neonatal hyperbilirubinaemia. The effect of albumin priming on the plasma volume, intravascular bilirubin, and HBABAbinding capacity during the subsequent 2 to 4j 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 HBABAbinding 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.

When is Serum Albumin Worth Measuring?

“…37 Albumin is frequently given to patients with severe bums after the first 24 h (during which time the high degree of vascular permeability renders it ineffective for increasing plasma volume). Maintenance of serum albumin levels above 20-25 giL reduces the development of oedema and may enhance healing.…”

Albumin Products

“…In one, the albumin serves as an adjunct to exchange transfusion for treat ment of hyperbilirubinemia in hemolytic disease of the newborn. Its effective ness for this indication is well documented [103][104][105][106] and evidently reflects the tight binding between bilirubin and albumin discussed previously [7,31]. The other use, i.e., in priming the heart-lung machine for cardiopulmonary bypass operations, appears safe, but its necessity is somewhat, uncertain.…”

CLINICAL ASPECTS OF ALBUMIN METABOLISM††This work was supported by Grant DR-6-83 from the Division of Research of the Lahey Clinic Foundation, Boston, Massachusetts.

“…(5455) The efficiency of exchange transfusion in conjunction with albumin infusion is dependent upon the timing of the albumin infusion. Tsao and Yu (55) showed that early priming with albumin, 3 hours prior to exchange transfusion, reduced the efficiency of the exchange: when albumin is added during the exchange transfusion, the efficiency is enhanced (Fig. 12).…”