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Abstract
Purpose :
We investigated the incidence and clinical course of hypoalbuminemia and identified relevance of prognosis including mortality in extremely low birth weight infants (ELBWIs). Also, we assessed the efficacy of intravenous albumin infusion.
Methods :
A retrospective study including 83 preterm infants <1,000 g of birth weight who were admitted to Ajou university hospital's neonatal intensive care unit from January 2008 to December 2012 was performed. Patients were divided into the normoalbuminemia (≥2.5 g/dL serum albumin, n=42) group and the hypoalbuminemia (<2.5 g/dL serum albumin, n=41) group, and also the hypoalbuminemia group were subdivided into the intravenous albumin infusion group (n=36) and the control group (n=5).
Results :
Of those 83 ELBWIs, 41 infants (49.4%) were classified as the hypoalbuminemia group. Associated conditions with hypoalbuminemia were patent ductus arteriosus (PDA, 19.5%), intraventricular hemorrhage (IVH, ≥grade III, 4.9%), necrotizing enterocolitis (NEC, ≥stage IIa, 46.3%), pneumonia (4.9%), sepsis (24.4%). In univariate analysis, there were no statistically significant differences in major morbidities such as PDA, IVH, NEC, bronchopulmonary dysplasia and mortality between the normoalbuminemia and the hypoalbuminemia groups except gestational age (26+6±2+1 vs. 26+0±1+5, P=0.045) and birth weight (868±117 vs. 783±121, P=0.002). In multivariate logistic regression, birth weight is the only meaningful factor associated with hypoalbuminemia (OR .995, 95% CI .990-.999, P=0.019). The mortality (47.2% vs. 0%, P=0.065) and morbidities did not differ between the intravenous albumin infusion and the control group.
Conclusion :
In ELBWIs, there were no significant differences in major morbidities and mortality between the hypoalbuminemia and the normoalbuminemia groups. The lower birth weight is the only factor associated with hypoalbuminemia. In addition, major morbidities and mortality rate were not affected by the albumin infusion.
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Table 1.
Differences of Demographic and Clinical Course in the Study Groups
| Albumin ≥2.5g/dL (n=42) | Albumin <2.5g/dL (n=41) | P-value | |
|---|---|---|---|
| Gestational age (weeks)∗ | 26+6±2+1 | 26+0±1+5 | .045 |
| Birth weight (g)∗ | 868±117 | 783±121 | .002 |
| Male, n (%) | 21(50) | 22 (53.7) | .827 |
| Apgar score 1 min† | 2.7 [2-3] | 2.7 [2-3] | .976 |
| Apgar score 5 min† | 4.0 [3-5] | 3.9 [3-5] | .624 |
| Hospital days (days) ∗ | 80.4±60.6 | 73.7±51.2 | .587 |
| Serum albumin (g/dL)∗ | 2.7±0.2 | 2.1±0.2 | <.001 |
| PDA, n (%) | 13 (31.0) | 15 (36.6) | .647 |
| BPD, n (%) | 12 (28.6) | 13 (31.7) | .814 |
| IVH ≥ grade III, n (%) | 7 (16.7) | 7 (17.1) | 1.000 |
| NEC≥ stage Iia, n (%) | 2 (4.8) | 2 (4.9) | 1.000 |
| Operated ROP, n (%) | 8 (19) | 6 (14.6) | .152 |
| Sepsis, n (%) | 23 (54.8) | 19 (46.3) | .513 |
| Mortality, n (%) | 12 (28.6) | 17 (41.5) | .255 |
Table 2.
Multivariate Analysis of Risk Factors for Hypoalbuminemia
| Risk factors | OR | 95% CI | P-value |
|---|---|---|---|
| Gestational age | .991 | 0.953-1.030 | .631 |
| Birth weight | .995 | 0.990-.999 | .019 |
Table 3.
Differences of Demographic and Clinical Course of Study Groups
| Albumin < 2.5 g/dL (n=41) | P-value | ||
|---|---|---|---|
| No Albumin infusion (n=5) | Albumin infusion(n=36) | ||
| Birth weight (g)∗ | 844±92 | 775±124 | .238 |
| Male gender, n (%) | 2 (40.0) | 20 (55.6) | .649 |
| Cesarean section, n (%) | 2 (40.0) | 25 (69.4) | .317 |
| Apgar score 1 min† | 3.0 [2-4] | 2.6 [2-3] | .536 |
| Apgar score 5 min† | 4.8 [4-5.5] | 3.8 [3-5] | .196 |
| Hospital days (days)∗ | 96.8±46.6 | 70.5±51.5 | .286 |
| Serum albumin (g/dL)∗ | 2.2±0.2 | 2.1±0.3 | .042 |
| Onset of hypoalbuminemia (days) | 21.6±9.8 | 16.5±11.4 | .350 |
| Recovery of hypoalbuminemia, n (%) | 5 (100.0) | 19 (52.8) | .065 |
| Duration of hypoalbuminemia (days) | 3.8±2.2‡ | 4.68±3.6 | .603 |
| PDA, n (%) | 1 (20.0) | 14 (38.9) | .636 |
| BPD, n (%) | 1 (20.0) | 12 (33.3) | 1.000 |
| IVH ≥ grade III, n (%) | 0 (0.0) | 7 (17.4) | .567 |
| NEC≥ stage Iia, n (%) | 0 (0.0) | 2 (5.6) | 1.000 |
| ROP, n (%) | 0 (0.0) | 6 (16.7) | 1.000 |
| Sepsis, n (%) | 3 (60.0) | 16 (44.4) | .649 |
| Mortality, n (%) | 0 (0.0) | 17 (47.2) | .065 |
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