Objectification of choosing albumin transfusion regimen in newborns during intensive care

The human albumin solution in intensive therapy contributes to effective hemodynamic stability, when it is necessary to limit the volume infusion. Indicators and dynamic markers of albumin infusion in newborns are conditionally defined. The choice of albumin therapy rate is subjective. Aim of the study was to investigate the predictive ability of albumin level in blood and urine for choosing regimen for albumin injection in newborns with severe somatic or surgical pathology.
Material and methods. A prospective comparative study was conducted involving newborns in the first week of life. Two groups were formed: somatic (n = 104) and surgical (n = 119). The human 10% albumin solution was included in the infusion therapy in two modes: mode 1 (shortened) ‒ up to 12 hours (median 8 hours), mode 2 (extended) ‒ up to 24 hours (median 20 hours). The albumin level in urine and blood in a complex of other indicators was determined at three stages (upon admission, on the first and third days after surgery).
Results. In the somatic group the need for albumin therapy in admission was determined by a decrease in its content in blood less than 27 g/l (sensitivity (Se) 54 %; specificity (Sp) 95 %), in the surgical group ‒ on the first day after surgery by reducing the colloid osmotic pressure less than 11,35 mmHg (Se 44 %; Sp 98 %). In both groups, on the third day, microalbuminuria more than 21,5 mg/l (Se 84 %, Sp 72 %) was associated with the albumin infusion. The prolonged infusion of 10% albumin solution (from 12 to 24 hours, 1 g/kg per day) is relevant for newborns with blood albumin content less than 25 g/l, regardless of the profile; if in the early postoperative period albuminuria exceeds 100 mg/l (Se 57 %, Sp 82 %; AUROC 0,820, standard error 0.052, p < 0.001), a shortened transfusion regimen (up to 12 hours) is indicated.
Conclusions. In intensive care of critically ill neonates, the need for correction of hypoalbuminemia is high. Clarification of the values of previously known indicators and the search for new diagnostic markers for albumin transfusion make it possible to use a differentiated approach when choosing drug administration regimens.

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