Journal List > Korean J Perinatol > v.24(4) > 1013687

Shon, Gwon, Lee, and Park: Hypoalbuminemia in Extremely Low Birth Weight Infants

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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Fig. 1
Postnatal trend of albumin level in patients (N=83).
kjp-24-244f1.tif
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

∗mean ± SD;

median [25%-75%] Abbrevations: PDA, patent ductus arteriosus; BPD, bronchopulmonary dysplasia; IVH, intraventricular hemorrhage; NEC, necrotizing enterocolitis; ROP, retinopathy of prematurity

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

Abbreviations: OR, odds ratio; CI, confidence interval

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

∗mean ± SD;

median [25%-75%];

(n=19) Abbrevations: PDA, patent ductus arteriosus; BPD, bronchopulmonary dysplasia; IVH, intraventricular hemorrhage; NEC, necrotizing enterocolitis; ROP, retinopathy of prematurity

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