Effect of Albumin Administration on Phototherapy for Neonatal Jaundice

Abstract

. Effect of albumin administration on phototherapy for neonatal jaundice. Two clinical trials were designed to test the effect of albumin administration before phototherapy for non-haemolytic neonatal jaundice. The first with 18 hours of phototherapy showed that the albumin-treated group (23 infants) had higher and more prolonged jaundice than the group (27 infants) given phototherapy alone.In the second study on 29 infants there were two groups as before, but the duration of phototherapy was increased to at least 48 hours and a third untreated group was included. These results showed significant differences between all three groups, the cases receiving phototherapy alone having the shortest and those receiving no specific therapy, the longest duration of jaundice.Those patients given albumin intravenously had significantly greater albuminbinding capacity at the end of treatment.It has been shown that administration of intravenous albumin raises the intravascular fraction of bilirubin (Odell, 1959a and b) (Wood, Comley, and Sherwell, 1970). Since phototherapy was introduced (Cremer, Perryman, and Richards, 1958), it has been shown to lower plasma bilirubin levels in neonatal jaundice (Broughton et al., 1965;Lucey, Ferreiro, and Hewitt, 1968).The present study was planned to observe the effect of albumin administered intravenously before phototherapy. It was also hoped to discover whether the light acted on the extravascular or intravascular component of bilirubin mass; thus, if light breaks down bilirubin in the extravascular space, then administration of albumin should decrease its effect by withdrawing bilirubin into the intravascular component. Conversely, administration of albumin should enhance the effect of phototherapy if it destroys the bilirubin circulating in the blood stream.

Effects of albumin infusion therapy on total and unbound bilirubin values in term infants with intensive phototherapy

“…Consequently, several reports 13–15 have focused on the effects of albumin administration on bilirubin–albumin binding affinity or on reserve albumin for the binding of bilirubin. An increase in serum albumin concentration was obtained, but occured mainly in the non‐binding fraction.…”

Relative roles of phototherapy and phenobarbitone in treatment of nonhaemolytic neonatal jaundice

“…Combined treatment as in I and II. It was not considered ethical to have controls, as results from a previous trial (Wong et al, 1972) had shown that about a third of the controls required therapy because the bilirubin level was rising to 20 mg/100 ml. 8 babies from a previous trial were therefore used as controls.…”

“…Phototherapy has been 704 Roles of phototherapy and phenobarbitone in treatment of nonhaemolytic neonatal jaundice 705 shown to be effective (Broughton et al, 1965;Lucey, Ferreiro, and Hewitt, 1968;Behrman and Hsia, 1969) even when treatment was not started until significant jaundice (plasma bilirubin > 15 mg/100 ml) had developed (Wong, Shuttleworth, and Wood, 1972). Furthermore, since the known mechanisms for reduction of jaundice by phenobarbitone and phototherapy are unrelated, it was decided to study the effect of these 2 treatments combined.…”

Bilirubin-albumin binding affinity and serum albumin concentration during intensive phototherapy (blue double light) in jaundiced newborn infants

“…Decrease of the serum albumin concentration as a consequence of phototherapy has previously been observed during ordinary phototherapy [19]. An explanation of this observation might be one of the following: a) A small amount of albumin might be photo-oxidized during the treatment, and the catabolic rate or the volume of distribution of this albumin might be greater than that of non-oxidized albumin [7].…”