Outcome of Fresh Frozen Plasma Versus Albumin in Priming Solution of Extracorporeal Circuit in Neonatal Cardiac Surgery: A Prospective Comparative Observational Study

Introduction: In neonatal cardiac surgery, the choice of cardiopulmonary bypass (CPB) priming fluid is crucial. Fresh frozen plasma (FFP) provides essential coagulation factors that can help reduce bleeding, while albumin helps maintain oncotic pressure and may protect renal function. This study aimed to compare the outcomes of FFP- based priming versus albumin-based priming.Methods: This prospective observational study was conducted from June 2022 to October 2024 and involved 100 neonates (weighing ≤5 kg) undergoing CPB. Patients were alternately assigned to receive 10 mL/kg of FFP (n = 50) or 5% albumin (n = 50) in the priming fluid. Outcomes included bleeding, transfusion requirements, hemodynamic stability, renal function, mechanical ventilation duration, intensive care unit (ICU) stay, hospital stay, and mortality. Data were analyzed using t tests and chi-square tests.Results: Baseline characteristics were similar between the two groups. Chest drain output and total blood product use were comparable (p > 0.05), except the FFP group required more albumin transfusion at 24 hours (p = 0.031). Hemodynamics were mostly similar, although mean arterial pressure was slightly higher in the albumin group at 48 hours (p = 0.040). Serum creatinine was significantly higher in the FFP group preoperatively and at 24–48 hours postoperatively (p ≈ 0.02–0.03), while urine output was similar. Duration of ventilation, ICU stay, hospital stay, and mortality showed no difference.Conclusion: Albumin priming may offer modest renal protection and reduce donor exposure. FFP remains an acceptable alternative. Larger randomized trials are required.