Uses & Misuses of Albumin in the NICU
Journal: Seminars in Fetal & Neonatal Medicine
-Reviews the use of albumin in the NICU and when we should/shouldn't use it - most often we shouldn’t
Albumin is the most abundant protein in plasma
Made in the liver as pre-proalbumin, once synthesized it is rapidly transferred to the plasma where it will cross the capillary wall to the ECS and be re-ciruclated intravascularly by the lymphatic system
Normal concentrations depend on GA - lots of variety. At birth it can range from 2-3 at term and increases by 15% in the first 3 weeks of life regardless of GA
Full term infants turn it over in 2-3 weeks, preterm infants in 5-7 days
Hypotension - poor evidence for its use, probably because usually the neonatal hypotension is not due to hypovolemia. There were also no differences in long term outcomes looking at LOS, days on MV, PDA, or IVH
Delivery Room Resuscitation - not recommended
Metabolic acidosis - not recommended
Pro-inflammatory states (AKA sepsis) - All the data is extrapolated from adult data - no use for albumin in neonates for sepsis or post-operative states
Hypoalbuminemia replacement - Low albumin might be physiological not pathological. Neonates may tolerate the lower levels as being normal - NOT recommended
Hyperbilirubinemia - it might make exchange transfusions work better, but not routinely recommended
Chylothorax - the ONLY indication that you might get away with using albumin but more recent reviews have shown that it is more important to ensure adequate nutrition and hydration
-Bottom line: there is no place (maybe one indication...) for the use of albumin of any kind in the NICU