- A systematic review of randomized controlled trials of human albumin
administration in critically ill adult patients with hypovolemia, burns
or hypoalbuminia strongly suggested that albumin increases mortality.2
- Additionally, meta-analysis of studies on fluid resuscitation in adult
patients has shown an association between the use of colloids and a
higher mortality in patients with capillary leak syndrome and adult
respiratory distress syndrome.3
- In another meta-analysis studying morbidity, 9 of 71 trials included
were performed in high-risk neonates. The relative risk for morbidity
with albumin administration was 0.82% (95% confidence interval of 0.66-1.01).
However, only 2 of these 9 RCTs specifically studied the administration
of albumin vs NS for the treatment of hypotension. Many of the other
7 were looking at albumin in premature infants with hypoproteinemia/
hypoalbuminemia. In the 2 trials that specifically addressed albumin
vs NS for the treatment of hypotension, a total of 74 events occurred
in the albumin group vs 61 events in the normal saline group. Therefore,
there may be selective situations where albumin may reduce morbidity
and others where it is harmful. Further research will need to be done
to delineate these clinical situations.4
- In sick preterm infants and in older patients with "capillary
leak syndrome", the net flow of fluid across the capillary may
be independent of the oncotic pressure between intravascular and extra
vascular compartments. In these patients plasma protein infused may
leak into the interstitial space, resulting in interstitial edema. In
infants with RDS, presence of edematous fluid and extravasation of plasma
protein into the alveolar space may cause inactivation of surfactant,
deterioration in lung mechanics, and inflammatory reactions that may
lead to development of chronic lung disease.
- A similar study to the one I chose was done at the University of Michigan
in 2003. In this study, 41 infants < 24 hours old were randomized
to receive either 5% albumin or normal saline as volume expander for
the treatment of hypotension. No difference was seen in response to
treatment measured by the need for a second bolus (43% vs. 35%, p=0.444)
or the need to go on inotropic support (19% vs. 15%, p=0.697).
This is another study which concluded that normal saline is as effective
as albumin for the treatment of hypotension in the newborn infant.5
- Speculative risks with albumin administration in neonates exist based
on the results of adult studies. Therefore, additional research with
a larger sample size is needed to detect differences in mortality and
complication rates including: chronic lung disease, intraventricular
hemorrhage, patent ductus arteriosus, and necrotizing enterocolitis.
KW, Fok TF, Ng PC, Wong WW, Cheung, KL. Randomised controlled trial
of colloid or crystalloid in hypotensive preterm infants. Arch Dis
Child Fetal Neonatal Ed 1997; 76:F43-6.
Injuries Group Albumin Reviewers. Human albumin administration in critically
ill patients: systematic review of randomised controlled trials. BMJ
1998; 317: 235-40.
V. Crystalloid versus colloid fluid resuscitation: A meta-analysis of
mortality. Surgery 1989; 105: 65-71.
JL, Navickis, RJ, Mahlon, MW. Morbidity in hospitalized patients receiving
human albumin: A meta-analysis of randomized, controlled trials. Critical
Care Medicine 2004; 32 (10): 2029-2038.
MJ, Nelson MN, Donn, SM. Randomized trial of normal saline versus 5%
albumin for the treatment of neonatal hypotension. Journal of Perinatology
2003; 23: 473-476.