Association of hypoalbuminemia and mortality risk in premature infants

Diminished circulating level of albumin is common in critically ill patients and the increased likelihood of poor outcomes in critically ill adult patients is well recognized. Several pediatric studies have also suggested an association between low serum albumin and adverse clinical sequeal such as prolonged length of intensive care stay and mortality. In this study, we evaluated the relationship between hypoalbuminemia and mortality in preterm infants smaller than 32 weeks of gestational age. One hundred and ninety nine infants with a mean birth weight of 1016±391 g, and a mean gestational age of 27.5±2.6 weeks were included in the study. The mean serum albumin was 3.06±0.47 mg/dl and serum albumin was correlated with gestational age (r =0.529; p=0.01). Patients were divided into two groups according to their gestational age as the infants with gestational age below 29 weeks and those with gestational age of 29 weeks and above. Serum albumin percentiles were established in these gestational age groups. Infants with serum albumin lower than 25 percentile were defined as the infants in hypoalbuminemia group. Prevalence of respiratory distress syndrome and early neonatal sepsis was significantly higher in hypoalbuminemia group. Proportion of infants of preeclamtic mothers was significantly lower, but proportion of infants without antenatal steroid exposure and proportion of infants of mothers with preterm labor was significantly higher in hypoalbuminemia group. No significant difference was found in length of ventilator and oxygen support and length of hospital stay between albumin percentile groups. Mortality was significantly higher in hypoalbuminemia group. Serum albumin concentrations lower than 2.72mg/dl was associated with mortality, with a sensitivity of 71% and a specificity of 86%. Logistic regression analysis showed that serum albumin lower than 25 percentile, and birth weight were independent predictive variables of mortality.