Randomized trial of normal saline versus 5% albumin for the treatment of neonatal hypotension.
OBJECTIVE
This study was designed to assess the comparative efficacy of normal saline (NS) and 5% albumin (ALB) for treatment of hypotension in the acutely ill newborn.


METHODS
Newborn infants who were < 24 hours old and were admitted to the Holden Neonatal Intensive Care Unit at the University of Michigan were randomized to receive one of the two solutions for volume expansion. Hypotension was defined as a sustained (> or =30 minutes) mean arterial pressure (MAP) of < 30 mmHg for infants weighing < or =2500 g, or a MAP of < 40 mmHg for those weighing > 2500 g. The short-term outcome measure was the resolution of hypotension defined as a MAP over the minimum limits set for birthweight sustained for > or =30 minutes.


RESULTS
In total 41 infants met criteria and were entered. Of these, 21 infants received ALB and 20 received NS. Successful treatment was seen in 17/21 (81%) of infants in the ALB group and 17/20 (85%) of infants in the NS group. There was no statistically significant difference in response to treatment (p=0.30). In addition, there was no statistically significant difference in the magnitude of change in MAP between the two (p=0.41).


CONCLUSIONS
NS was shown to be as effective as ALB for the correction of acute hypotension in the newborn infant. Given comparable efficacy of NS, along with its relatively low cost and availability, it should be considered the initial treatment of choice in this setting.
D000418:Albumins / Q000627:therapeutic use*; D003102:Colloids; D000077324:Crystalloid Solutions; D005260:Female; D005865:Gestational Age; D006400:Hematocrit; D006801:Humans; D007022:Hypotension / Q000188:drug therapy*; D007231:Infant, Newborn; D007262:Infusions, Intravenous; D007552:Isotonic Solutions; D008297:Male; D010952:Plasma Substitutes; D015532:Rehydration Solutions / Q000627:therapeutic use; D012462:Saline Solution, Hypertonic; D012965:Sodium Chloride / Q000627:therapeutic use*
D000418:Albumins; D003102:Colloids; D000077324:Crystalloid Solutions; D007552:Isotonic Solutions; D010952:Plasma Substitutes; D015532:Rehydration Solutions; D012462:Saline Solution, Hypertonic; D012965:Sodium Chloride