The Effect of Intravenous Albumin Administration Before Exchange Transfusion in Infants With Hyperbilirubinemia: A Meta-Analysis.

Abstract

<h4>Background and aims</h4>This meta-analysis aimed to assess the impact of intravenous albumin administration before exchange transfusion in infants diagnosed with hyperbilirubinemia.<h4>Methods</h4>A comprehensive search was conducted in multiple electronic databases, including PubMed (Medline), Scopus, Embase, Web of Science, Cochrane Library, and ClinicalTrials.gov, using relevant keywords. The quality of the included randomized controlled trials (RCTs) was evaluated using the Cochrane Risk of Bias tool. Statistical analyses were performed using STATA (Version 18) and RevMan (Version 5).<h4>Results</h4>Four RCTs met the inclusion criteria. Pooled analysis indicated a nonsignificant reduction in total bilirubin levels following intravenous albumin administration (SMD: -2.19; 95% CI: -4.79 to 0.41; <i>I</i>² = 68.03%; <i>p</i> for heterogeneity = 0.001). Subgroup analysis revealed no significant reduction in early bilirubin measurements (≤ 6 h), but a statistically significant reduction was observed in later measurements (12-24 h) (SMD: -2.91; 95% CI: -4.93 to -0.89). The duration of phototherapy was significantly reduced in the albumin group compared to placebo (WMD: -11.23; 95% CI: -21.28 to -1.19; <i>I</i>² = 76.12%; <i>p</i> for heterogeneity = 0.03).<h4>Conclusion</h4>While intravenous albumin administration before exchange transfusion did not show a statistically significant effect on total bilirubin levels overall, a potential bilirubin-lowering effect was observed when measured at later time points. Moreover, albumin significantly reduced the duration of phototherapy. These findings suggest potential clinical benefit, though further high-quality RCTs are warranted.