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Hypoproteinemia on the first day of life and adverse outcome in very preterm infants admitted to the neonatal intensive care unit

Journal of Perinatology volume 32, pages 520–524 (2012)Cite this article

Abstract

Objective:

We aimed to investigate the relationship between day-1 hypoproteinemia and severe adverse outcome (SAO) in very preterm infants admitted to the neonatal intensive care unit (NICU).

Study Design:

Retrospective study of all patients born from 24 to 31 weeks gestation and cared for in our NICU over an 8-year period. Infants were excluded if the serum protein value on the first day of life was not available.

Result:

A total of 913 patients were included. In all, 14.6% presented with SAO (death or severe neurological injury on cranial ultrasound). Hypoproteinemia (total protein level <40 g l−1) on day 1 of life occurred in 19.5 % of all patients. The rate of SAO was 33.7% in patients with hypoproteinemia and 9.9% in those with normoproteinemia (P<0.0001). Logistic and multiple regression analysis confirmed that the association hypoproteinemia–SAO remained significant after adjustment for the other major predictors of outcome present at baseline (odds ratio 3.4; 95% confidence interval 2.1–5.4; P<0.0001).

Conclusion:

Hypoproteinemia was highly associated with SAO in this cohort of critically ill preterm infants. We are unable to explain the link between hypoproteinemia and adverse outcome in our population. This investigation serves as a hypothesis-generating report of a large preterm infants sample, and suggests the need to assess the predictive accuracy for adverse outcome of hypoproteinemia in future prospective studies.

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References

  1. Mangialardi MJ, Martin GS, Bernard GS, Wheeler AP, Christman BW, Dupont WD et al. Hypoproteinemia predicts acute respiratory distress syndrome development, weight gain, and death in patients with sepsis. Crit Care Med 2000; 28 (9): 3137–3145.

    Article  CAS  Google Scholar 

  2. Vincent Jl, Dubois MJ, Navickis RJ, Wilkes MM . Hypoalbuminemia in acute illness: is there a rationale for intervention? A meta-analysis of cohort studies and controlled trials. Ann Surg 2003; 237: 319–334.

    PubMed  PubMed Central  Google Scholar 

  3. Horowitz IN, Ta K . Hypoalbuminemia in critically ill children. Arch Pediatr Adolesc Med 2007; 161 (11): 1048–1052.

    Article  Google Scholar 

  4. Uhing MR . The albumin controversy. Clin Perinatol 2004; 31: 475–488.

    Article  Google Scholar 

  5. Kenny SE, Pierro A, Isherwood D, Donnell SC, Van Saene HK, Lloyd DA et al. Hypoalbuminaemia in surgical neonates receiving parenteral nutrition. J Pediatr Surg 1995; 30 (3): 454–457.

    Article  CAS  Google Scholar 

  6. Atkinson SD, Tuggle DW, Tunell WP . Hypoalbuminemia may predispose infants to necrotizing enterocolitis. J Pediatr Surg 1989; 24 (7): 674–676.

    Article  CAS  Google Scholar 

  7. Morris I, McCallion N, El-Khuffash A, Molloy EJ . Serum albumin and mortality in very low birth weight infants. Arch Dis Child Fetal Neonatal Ed 2008; 93 (4): F310–F312.

    Article  CAS  Google Scholar 

  8. Gouyon JB, Bouziane M, Semama DS . Objectifs des apports hydrosodés dans la première semaine de vie du prématuré: comment les atteindre? In: Gouyon JB, Guignard JP, Simeoni U (eds). Equilibre hydroélectrolytique du grand prématuré. Arnette: Paris, 1997, pp 101–118.

    Google Scholar 

  9. Papile LA, Burstein J, Burstein R, Koffler H . Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1500 gm. J Pediatr 1978; 92 (4): 529–534.

    Article  CAS  Google Scholar 

  10. deVries LS, Eken P, Dubowitz LMS . The spectrum of leukomalacia using cranial ultrasound. Behav Brain Res 1992; 49: 1–6.

    Article  CAS  Google Scholar 

  11. Cornet B, Gouyon JB, Binquet C, Sagot P, Ferdynus C, Metral P et al. Using discharge abstracts as a tool to assess a regional perinatal network. Rev Epidemiol Sante Publique 2001; 49 (6): 583–593.

    CAS  Google Scholar 

  12. Quantin C, Allaert FA, Gouyon B, Cohen O . Proposal for the creation of a European healthcare identifier. Stud Health Technol Inform 2005; 116: 949–954.

    Google Scholar 

  13. Hadlock FP, Harrist RB, Martinez-Poyer J . In utero analysis of fetal growth: a sonographic weight standard. Radiology 1991; 181 (1): 129–133.

    Article  CAS  Google Scholar 

  14. Doyle JJ, Schmidt B, Blanchette V, Zipursky A . Hematology In: Avery GB, Fletcher MA, Mac Donald MG (eds). Neonatology, Pathophysiology and Management of the Newborn. Lippincott Williams & Wilkins: Philadelphia, 1999, pp 1045–1092.

    Google Scholar 

  15. Choker G, Gouyon JB . Diagnosis of acute renal failure in very preterm infants. Biol Neonate 2004; 86 (3): 212–216.

    Article  CAS  Google Scholar 

  16. Reading RF, Ellis R, Fleetwwod A . Plasma albumin and total protein in preterm babies from birth to eight weeks. Early Hum Dev 1990; 22 (2): 81–87.

    Article  CAS  Google Scholar 

  17. Kero P, Korvenranta H, Alamaakala P, Selänne P, Kiilholma P, Välimäki I . Colloid osmotic pressure of cord blood in relation to neonatal outcome and mode of delivery. Acta Paediatr Scand Suppl 1983; 305: 88–91.

    Article  CAS  Google Scholar 

  18. Bhat R, Javed S, Malalis L, Vidyasagar D . Critical care problems in neonates. Colloid osmotic pressure in healthy and sick neonates. Crit Care Med 1981; 9 (8): 563–567.

    Article  CAS  Google Scholar 

  19. Zimmermann B, Françoise M, Germain GF, Lallemant C, Gouyon JB . Colloid oncoticpressurein neonatal respiratory distress syndrome. Arch Pediatr 1997; 4: 952–958.

    Article  CAS  Google Scholar 

  20. Verhagen EA, Ter Horst HJ, Keating P, Martijn A, Van Braeckel KN, Bos AF . Cerebral oxygenation in preterm infants with germinal matrix-intraventricular hemorrhages. Stroke 2010; 41 (12): 2901–2907.

    Article  CAS  Google Scholar 

  21. Watkins AM, West CR, Cooke RW . Blood pressure and cerebral haemorrhage and ischaemia in very low birthweight infants. Early Hum Dev 1989; 19 (2): 103–110.

    Article  CAS  Google Scholar 

  22. Bunt JE, Rietveld T, Schierbeek H, Wattimena JL, Zimmermann LJ, van Goudoever JB . Albumin synthesis in preterm infants on the first day of life studied with [1-13C]. Am J Physiol Gastroinest Liver Physiol 2007; 292 (4): G1157–G1161.

    Article  CAS  Google Scholar 

  23. Scott PH, Wharton BA . Biochemical values in the newborn In: Roberton RNC (ed). Textbook of Neonatology. Roberton: New York, 1992, pp 1213–1227.

    Google Scholar 

  24. Jardine LA, Jenkins-Manning S, Davies MW . Albumin infusion for low serum albumin in preterm newborn infants. Cochrane Database Syst Rev 2004; (3): CD004208.

  25. Lynch SK, Mullet MD, Graeber JE, Polak MJ . A comparison of albumin-bolus therapy versus normal saline-bolus therapy for hypotension in neonates. J Perinatol 2008; 28 (1): 29–33.

    Article  CAS  Google Scholar 

  26. Ghirardello S, Mosca F . Albumin versus saline: an open question. J Perinatol 2008; 28 (8): 586.

    Article  CAS  Google Scholar 

  27. Bignall S, Bailey PC, Bass CA, Cramb R, Rivers RP, Wadsworth J . The cardiovascular and oncotic effects of albumin infusion in premature infants. Early Hum Dev 1989; 20 (3–4): 191–201.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Pediatrics, Neonatal Intensive Care Unit, Dijon University Hospital, Dijon, France

    S Iacobelli, F Bonsante, C Lacoutière & J B Gouyon

  2. Centre d’Epidémiologie des Populations (EA4184), Université de Dijon, Dijon, France

    C Ferdynus & J B Gouyon

  3. CHRU, Service de Biostatistique et d’Informatique Médicale, Dijon, France

    J Cottenet & C Quantin

  4. INSERM CIE1, Dijon, France

    C Binquet

  5. CHRU Dijon, Centre d’Investigation Clinique - Epidémiologie Clinique/Essais Cliniques, Dijon, France

    C Binquet

  6. Université de Bourgogne, Dijon, France

    C Binquet

  7. INSERM U866, Dijon, France

    S Iacobelli & C Quantin

Authors
  1. S Iacobelli
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  2. F Bonsante
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  3. C Lacoutière
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  6. C Binquet
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  7. C Quantin
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  8. J B Gouyon
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Correspondence to S Iacobelli.

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Iacobelli, S., Bonsante, F., Lacoutière, C. et al. Hypoproteinemia on the first day of life and adverse outcome in very preterm infants admitted to the neonatal intensive care unit. J Perinatol 32, 520–524 (2012). https://doi.org/10.1038/jp.2011.137

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  • DOI: https://doi.org/10.1038/jp.2011.137

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