Early albumin infusion to infants at risk for respiratory distress.

In a randomized prospective study, 100 high-risk infants (selected on the basis of a cord serum protein level of 4·6 g/100 ml or less, gestational age under 37 weeks, birthweight 2500 g or less, and/or arterial H below 7·25) received 8 ml/kg of either 25% salt-poor albumin or 5% dextrose in water before the age of 2 hours. All infants were then managed supportively with warmth, appropriate oxygen supplementation, isotonic fluid infusion, and close monitoring, without further administration of colloid or hypertonic alkali solutions over the first 4 hours of life. No statistically significant difference was shown between early colloid and early dextrose-water administration for either the incidence of idiopathic respiratory distress syndrome (RDS) or the mortality of high-risk infants, suggesting no apparent advantage of albumin over simple glucose-water infusion to hypoproteinaemic newborns shortly after birth. However, among the infants of 28 weeks' gestation or less admitted to the study, 3 of 4 albumin-treated patients survived, while 5 comparable infants in the dextrose-water group died within 12 hours of birth. For the 100 infants taken together there was a significant improvement in morbidity and mortality from previous experience in the same nursery, indicating that prompt supportive care, including early fluid administration, may be instrumental in reducing the incidence and severity of RDS.