Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Comment
  • Published:

Albumin in neonates: use it or lose it

Pediatric Research (2025)Cite this article

Access through your institution
Buy or subscribe

Commentary on: Vander Elst Z, Laenen A, Deberdt J, Delemarre L, Vermeersch P, Frans G, Naulaers G, Gijsen M, Dreesen E, Spriet I, Allegaert K, Smits A. Human serum albumin: prediction model and reference values for preterm and term neonates. Pediatr Res. 2024 Oct 11. https://doi.org/10.1038/s41390-024-03634-1. Epub ahead of print. PMID: 39394426.

Albumin is a commonly measured protein moiety that is crucial for drug-binding and maintaining intravascular volume and providing 80% of colloid osmotic pressure.1 Albumin is important for antioxidant properties, binding and transporting substances such as drugs. Hypoalbuminaemia is a negative prognostic factor in critically ill neonates and children.2 Different concentrations of albumin are available. Albumin at 5% infusion is used for volume expansion and 20% albumin has been used to correct hypoalbuminemia and oedema since the 1940s. Debate continues about the use of colloid in the form of albumin versus crystalloid in fluid resuscitation. In addition, there are rare but potential risks such as transmission of infection, allergic effects and anticoagulation.1 Congenital analbuminemia (CAA) is an autosomal recessive disorder with an incidence of 1:1,000,000 live births and defined by the absence of serum albumin. Analysis of the albumin (ALB) gene is needed for the molecular diagnosis.3 Over 90 cases have been reported worldwide with a wide variety of clinical phenotypes from early mortality to minimal symptomatology.3

This is a preview of subscription content, access via your institution

Access options

Access through your institution

Buy this article

  • Purchase on SpringerLink
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

References

  1. Vincent, J. L., De Backer, D. & Wiedermann, C. J. Fluid management in sepsis: The potential beneficial effects of albumin. J. Crit. Care 35, 161–167 (2016).

    Article  PubMed  CAS  Google Scholar 

  2. Morris, I., McCallion, N., El-Khuffash, A. & Molloy, E. J. Serum albumin and mortality in very low birth weight infants. Arch. Dis. Child Fetal Neonatal Ed. 93, F310–F312 (2008).

    Article  PubMed  CAS  Google Scholar 

  3. Minchiotti, L. et al. Diagnosis, phenotype, and molecular genetics of congenital Analbuminemia. Front. Genet. 10, 336 (2019).

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  4. Vander Elst, Z. et al. Human serum albumin: prediction model and reference values for preterm and term neonates. Pediatr. Res. 2024. https://doi.org/10.1038/s41390-024-03634-1.

  5. Vincent, J. L., Dubois, M. J., Navickis, R. J. & Wilkes, M. M. Hypoalbuminemia in acute illness: is there a rationale for intervention? A meta-analysis of cohort studies and controlled trials. Ann. Surg. 237, 319–334 (2003).

    Article  PubMed  PubMed Central  Google Scholar 

  6. Luo, H. C., Fu, Y. Q., You, C. Y., Liu, C. J. & Xu, F. Comparison of admission serum albumin and hemoglobin as predictors of outcome in children with moderate to severe traumatic brain injury: A retrospective study. Medicine 98, e17806 (2019).

  7. Low, E., Healy, M. & Molloy, E. J. Neonatal albumin infusions in paediatric intensive care. Arch. Dis. Child Fetal Neonatal Ed. 95, F149 (2010).

    Article  PubMed  CAS  Google Scholar 

  8. Uhing, M. R. The albumin controversy. Clin. Perinatol. 31, 475–488 (2004).

    Article  PubMed  Google Scholar 

  9. Morris, I. & Molloy, E. J. Albumin administration in the management of neonatal hypoalbuminaemia. Arch. Dis. Child Fetal Neonatal Ed. 93, F326 (2008).

    Article  PubMed  CAS  Google Scholar 

  10. Subcommittee on Hyperbilirubinemia Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics 114, 297–316 (2004).

    Article  Google Scholar 

  11. Shalish, W., Olivier, F., Aly, H. & Sant’Anna, G. Uses and misuses of albumin during resuscitation and in the neonatal intensive care unit. Semin. Fetal Neonatal Med. 22, 328–335 (2017).

    Article  PubMed  Google Scholar 

  12. Jardine L. A., Jenkins-Manning S., Davies M. W. Albumin infusion for low serum albumin in preterm newborn infants. Cochrane Database Syst. Rev. (2004) Cd004208. https://doi.org/10.1002/14651858.CD004208.pub2.

  13. Branagan, A., Costigan, C. S., Stack, M., Slagle, C. & Molloy, E. J. Management of acute kidney injury in extremely low birth weight infants. Front. Pediatr. 10, 867715 (2022).

    Article  PubMed  PubMed Central  Google Scholar 

  14. Schierhout, G. & Roberts, I. Fluid resuscitation with colloid or crystalloid solutions in critically ill patients: a systematic review of randomised trials. BMJ 316, 961–964 (1998).

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  15. Wigmore, G. J. et al. HAS FLAIR-II investigators. Twenty percent human albumin solution fluid bolus administration therapy in patients after cardiac surgery-II: a multicentre randomised controlled trial. Intensive Care Med. 50, 1075–1085 (2024).

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  16. Caironi, P. et al. ALBIOS Study Investigators. Albumin replacement in patients with severe sepsis or septic shock. N. Engl. J. Med. 370, 1412–1421 (2014).

    Article  PubMed  CAS  Google Scholar 

  17. Dubois, M. J. et al. Albumin administration improves organ function in critically ill hypoalbuminemic patients: A prospective, randomized, controlled, pilot study. Crit. Care Med. 34, 2536–2540 (2006).

    Article  PubMed  CAS  Google Scholar 

  18. C Callum, J. et al. International Collaboration for Transfusion Medicine Guidelines Intravenous Albumin Guideline Group. Use of Intravenous Albumin: A Guideline From the International Collaboration for Transfusion Medicine Guidelines. Chest 166, 321–338 (2024).

    PubMed  Google Scholar 

  19. Nada, A. et al. Low albumin levels are independently associated with neonatal acute kidney injury: a report from AWAKEN Study Group. Pediatr. Nephrol. 37, 1675–1686 (2022).

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Discipline of Paediatrics, Trinity College Dublin, the University of Dublin, Dublin, Ireland

    Eleanor J. Molloy

  2. Trinity Translational Medicine Institute (TTMI), St James Hospital & Trinity Research in Childhood Centre (TRiCC), Dublin, Ireland

    Eleanor J. Molloy

  3. Neurodisability, Children’s Health Ireland (CHI) at Temple Street, Dublin, Ireland

    Eleanor J. Molloy

  4. Neonatology, CHI at Crumlin, Dublin, Ireland

    Eleanor J. Molloy

  5. Paediatrics, Coombe Hospital, Dublin, Ireland

    Eleanor J. Molloy

  6. UH Rainbow Babies & Children’s Hospitals, Cleveland, OH, USA

    Cynthia F. Bearer

  7. Case Western Reserve University School of Medicine, Cleveland, OH, USA

    Cynthia F. Bearer

Authors
  1. Eleanor J. Molloy
    View author publications

    Search author on:PubMed Google Scholar

  2. Cynthia F. Bearer
    View author publications

    Search author on:PubMed Google Scholar

Corresponding author

Correspondence to Eleanor J. Molloy.

Ethics declarations

Competing interests

The authors declare no competing interests.

Ethical approval

Ethical approval was not required for this review of the literature.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Molloy, E.J., Bearer, C.F. Albumin in neonates: use it or lose it. Pediatr Res (2025). https://doi.org/10.1038/s41390-025-04311-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1038/s41390-025-04311-7

Search

Advanced search

Quick links