Effect of Pre-exchange Transfusion Albumin Infusion on Neonatal Hyperbilirubinemia: A Meta-Analysis of Randomized Clinical Trials

Objectives: This study was carried out to systematically evaluate the efficacy and safety of pre-exchange transfusion (pre-ET) albumin infusion on neonatal hyperbilirubinemia. Methods: A comprehensive search of relevant studies from EMBASE, Medline, Cochrane Register of Controlled Trials, ClinicalTrials.gov, China National Knowledge Infrastructure, Wei Pu Information, Wan Fang Data, and Chinese Biomedical Literature Database was conducted from inception to December 2021. Two different authors screened the titles, abstracts, and full texts of the articles. The quality of the included trials was assessed independently by two different authors according to the Cochrane Collaboration’s Risk of Bias. The data were analyzed and compiled using Review Manager software (RevMan version 5.3). Results: In total, four studies enrolling 195 neonates were included in this review. The quality of the included studies was deemed fair to good. The meta-analysis showed that pre-ET albumin infusion was superior to exchange transfusion (ET) alone for reducing the need for repeating ET (risk ratio (RR) = 0.25, 95% confidence interval (CI): 0.09 - 0.72, I-squared (I2) = 8%; fixed effects model) and shortening the duration of phototherapy (PT) (mean difference (MD) = -11.46 hours, 95% CI: -16.56 to -6.36, I2 = 93%; random effects model (REM)). No significant differences were detected between the two groups for post-ET total serum bilirubin (TSB) at 6 hours (MD = -3.51 mg/dL, 95% CI: -7.93 - 0.93, I2 = 97%; REM) and 12 hours (MD = -4.21 mg/dL, 95% CI: -9.08 - 0.65, I2 = 99%; REM). None of the patients developed acute bilirubin encephalopathy in any of the trials. No death prior to hospital discharge was reported in any trials, and no adverse effects were observed in intervention groups. Conclusions: Based on four studied trials, pre-ET albumin infusion appears to be safe and effective in reducing the need for repeating ET and shortening PT duration. These potential benefits, including the reduction of post-ET TSB, need to be revalidated in future trials using rigorous methodology.