Investigation of faktors affecting plasma protein levesls in preterm infants and their effects on morbidity and mortality

Low plasma protein levels may decrease the intravascular compartment volume and blood pressure and cause deterioration of adequate blood flow to vital organs, thus facilitating the occurrence of serious adverse outcomes, mortality and morbidities. These observations have led us to perform a study to determine the relationship between hypoproteinemia on first day of life and severe adverse outcomes, mortality and morbidities in infants born below <32 weeks gestation. This was a prospepective study conducted in the NICU of the Bursa Uludağ University Faculty of Medicine between September 2019 and December 2021. All the infants hospitalized in our neonatal intensive care unit (NICU) had a blood sample at 24 hours of life. Patients were exclude if the serum protein value on the first day of life was not avaible or if they had major congenital malformations. Serum total protein values were significantly different in infants who with severe adverse outcome (p=0,013). The median score value of SNAP-2 and SNAPPE-2 was calculated to be higher in infants with hypoproteinemia. SNAP-2 and SNAPPE-2 predicted severe adverse outcome significantly better than plasma protein levels and albumin levels (p=0,032 p=0,017), while no significant difference was seen with SNAP-2 (p=0,280) . Mortality occured higher in the group with hypoproteinemia (p<0,001). SNAP-2 and SNAPPE-2 predicted mortality significantly better than plasma protein levels (p=0,032 p=0,017) and albumin levels, while no significant difference was seen with SNAP-2 (p=0,086). There is not yet an objective scoring system that can reach a consensus for mortality scores used to predict disease severity and mortality risk. Albumin is one of the components of the Acute Physiology and Chronic Health Assessment-III scoring system. But there is no scoring system that includes the plasma protein levels. Hypoproteinemia is an importent marker with among the morbidities respiratory distress syndrome (RDS), patent ductus arteriosus (HAPDA), intraventricular hemorrhage (IVK), bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), hypotension and mortality. By adding a score created according to plasma protein level to the SNAPPE-2, which is currently used most frequently in the NICU, its power to indicate severe advers outcome and mortality can be increased.