A comparison of albumin-bolus therapy versus normal saline-bolus therapy for hypotension in neonates

Objective: We compared responses to bolus infusion of 5% albumin (ALB) or normal saline (NS) for hypotension in neonates. Study Design: Hypotensive infants were given 10 ml kg −1 of NS or ALB. A second bolus was given for persistent hypotension. Dopamine therapy was started for hypotension after the second bolus. The primary response was increase in arterial blood pressure toward normal range 1 h postinfusion. Secondary measures included duration of normotension, meeting criteria for second bolus, meeting criteria for vasopressor support and cost comparison. Result: Those receiving ALB ( N =49 ALB and 52 NS) were more likely to achieve a normotensive state (ALB=57.1%, NS=32.1% P =0.01) 1 h following the initial bolus therapy. Subsequently, the NS group was also more likely to qualify for vasopressor infusion (ALB=24.5%, NS=44.2% P =0.02). Overall cost for either therapy was equivalent. Conclusion: In hypotensive neonates, ALB results in a greater likelihood of achieving normotension and decreased subsequent use of vasopressors when compared to NS.