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Neonatal Intensive Care Drug Manual
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| bet | 42/654 | | Sana | 03.01.2022 | | Hajmi | 1,5 Mb. | | #14803 |
Special Comments
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Evidence summary
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Efficacy
Hypoalbuminemia: Two randomised, controlled trials (RCT) [1, 2] have compared 5 mL/kg albumin 20% (1 g/kg) infusion in preterm infants with plasma albumin <30 g/L, although one of the studies did not report major clinical outcomes. The other study [2] reported no difference in mortality (RR 1.5, 95% CI 0.3–7.43), peri/intraventricular haemorrhage (PIVH), patent ductus arteriosus (PDA), necrotising enterocolitis (NEC), bronchopulmonary dysplasia (BPD), duration of mechanical ventilation and oxygen therapy. Systematic review concluded there is a lack of evidence from randomised trials to determine whether the routine use of albumin infusion in preterm neonates with low serum albumin reduces mortality or morbidity and no evidence to assess whether albumin infusion is associated with significant side effects [3].
A systematic review of RCTs comparing albumin or plasma protein fraction (PPF) with no albumin or PPF or with a crystalloid solution in critically ill patients with hypoalbuminaemia included 12 trials with 121 deaths among 757 participants [4]. Several trials were in newborn infants although no subgroup analysis was performed. Overall, for hypoalbuminaemia the relative risk for mortality was 1.26 (95% CI 0.84 to 1.88).
Conclusion: There is insufficient evidence to determine the efficacy and safety of albumin 20% infusion in newborn infants with hypoalbuminaemia. [LOE II GOR D] Recommendation is for albumin infusion to only be considered in neonates with overwhelming continuous albumin loss including significant chylothorax, high-output ostomy drainage and severe congenital nephrotic syndrome [5].
Chylothorax: Although chyle contains 22.4 g/L (12.6 to 30) of albumin, there are no studies of albumin replacement in high-output chylothorax and recent reviews on chylothorax management have not recommended albumin infusion [5, 6].
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