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jsmc-10031


ROLE OF INTRAVENOUS HUMAN ALBUMIN IN MANAGEMENT OF NEONATAL HYPERBILIRUBINEMIA


Awat Shokri Ismael * and Abbas Abdulqadir Alrabaty **


*  Raparin Pediatric Teaching Hospital, Erbi, Kurdistan Region, Iraq.
** Hawler Medical University and Consultant Neonatologist, Raparin Pediatric Teaching Hospital.


Submitted: 3/9/2012; Accepted: 9/2/2013Published 1/6/2013


ABSTRACT


Background

Bilirubin is a known toxin to the newborn nervous system. Hyperbilirubinemia is treated by phototherapy and exchange blood transfusion; the intravenous infusion of human albumin can reduce the post-exchange serum bilirubin level and shorten duration of phototherpy and hence admission to hospital.

Objectives

To determine the role of intravenous administration of human albumin prior to exchange transfusion in term neonates with neonatal hyperbilirubinemia for reduction of serum bilirubin.

Patients and Methods

In this Study, fifty out-born term neonates with gestational age of >37 weeks and birth weight of >2500 grams, but otherwise healthy with high serum bilirubin required blood exchange immediately or after intensive phototherapy failure; were admitted to the neonatal unit of Raparin Pediatric Teaching Hospital in Erbil. The 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 without intravenous human albumin.

Results

The mean total serum bilirubin (TSB) level in the albumin treated group was significantly lower than that in the control group at 6, 12 and 24 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 (22.7±2.4 vs. 36±8.2 hours) respectively, (P<0.001). None of the neonates in the albumin treated group needed second exchange transfusion and no complications were observed.

Conclusion

Infusion of 20% albumin (1 g/kg) one hour prior to blood exchange transfusion can significantly reduce the post-exchange TSB, duration of phototherapy and the total duration of hospital admission.

KEYWORDS

Intravenous Albumin, Neonatal Hyperbilirubinemia.

References 

1. Boamah LM, Balistreri WF. Manifestations of liver disease. In: Nelson Textbook of Pediatrics. Kliegman RM. Santon BF, St.Geme III JW, Schor NF, Behrman RE.(eds) 19th edition (2011), Elsevier Saunders, Philadelphia. Pp. 1375.

2. Minkovitz CS, Wissow LS. Evaluating and using laboratory tests. In: Oski's Pediatrics principles and practice. Mc Millian JA,  DeAngelis CD, Feigin RD an Warshaw JB., 3rd edition (1994), Lippincott Williams and Wilkins, Philadelphia. Pp. 123-130

3. Ebbesen F, Jacobsen J. Bilirubin- albumin binding affinity and serum albumin concentration during intensive phototherapy (blue double light) in jaundiced newborn infants. Eur J Pediatr 1980; 134: 261-263.

4. Porter EG, Waters WJ. A rapid micro method for measuring the reserve albumin binding capacity in serum from newborn infants with hyperbilirubinemia. J Lab Clin Med 1966; 67: 660-668. 

5. Wood B, Comley A, Sherwell J. Effect of additional albumin administration during exchange transfusion on plasma albumin-binding capacity. Arch Dis Child 1970; 45: 59-62.

6. Hosono S, Ohno T, Kimoto H, Nagoshi R, Shimizu M, Nozawa M. Follow-up study f auditory brainstem responses in infants with high unbound bilirubin levels treated with albumin infusion therapy. Pediatr Int 2002; 44: 488-492.

7. Shahian M, Moslehi MA. Effect of albumin administration prior to exchange transfusion in term neonates with hyperbilirubinemia: a randomized controlled trial. Indian Pediatr 2010; 47: 241-244.

8. Mcintosh N. The Newborn. In: Forfar and Arneil’s text book of pediatrics 5th edition(1998), Churchill Livingstone, New York. Pp:129.

9. Maisels MJ, Kring E. Bilirubin rebound following intensive phototherapy. Arch Pediatr Adolesc Med.2002;156 :669– 672.

10. Yetman RJ,  Parks DK,  Huseby V,  Mistry K,  Garcia J. Rebound bilirubin levels in infants receiving phototherapy. J   Pediatr.1998; 133 :705– 707.

11. Lazar L, Litwin A, Merlob P. Phototherapy for neonatal non hemolytic hyperbilirubinemia. Analysis of rebound and indications for discontinuing therapy. Clin Pediatr (Phila).1993;32 :264– 267.

12. Funato M, Tamai H,  Shimada S  & Nakamura H. Vigintiphobia. Unbound bilirubin and auditory brain stem responses. Pediatrics, 1994 ; 93 : 50–3.

13. Hosono, S., Ohno, T., Kimoto, H., Nagoshi, R., 
Shimizu, M. and Nozawa, M., (2001). Effects of albumin infusion therapy on total and unbound bilirubin values in term infants with intensive phototherapy. Pediatrics International,2001 ; 43: 8–11.

14. Odell, G. B. (1959a). Studies in kernicterus I. The protein binding of bilirubin. Journal of Clinical Investigation, 38, 823.