Neonatal Intensive Care Unit, Department of Pediatrics, Dijon University Hospital, Dijon, France.
J Perinatol. 2012 Jul;32(7):520-4. doi: 10.1038/jp.2011.137. Epub 2011 Sep 29.
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).
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.
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).
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.
我们旨在研究极低出生体重儿（VLBWI）入院新生儿重症监护病房（NICU）时第 1 天低蛋白血症与严重不良结局（SAO）的关系。
回顾性研究了 8 年间在我们 NICU 接受治疗的所有 24 至 31 孕周出生的患者。如果第 1 天的血清蛋白值不可用，则将患者排除在外。
共纳入 913 例患者。共有 14.6%的患者出现 SAO（头颅超声显示死亡或严重神经损伤）。19.5%的患者在生命第 1 天存在低蛋白血症（总蛋白水平<40g/L）。低蛋白血症患者的 SAO 发生率为 33.7%，而正常蛋白血症患者的发生率为 9.9%（P<0.0001）。逻辑回归和多元回归分析证实，在校正基线时其他主要结局预测因素后，低蛋白血症-SAO 之间的关联仍然显著（比值比 3.4；95%置信区间 2.1-5.4；P<0.0001）。
在本队列危重早产儿中，低蛋白血症与 SAO 高度相关。我们无法解释我们人群中低蛋白血症与不良结局之间的联系。本研究是对大量早产儿样本的假设生成报告，并表明需要在未来的前瞻性研究中评估低蛋白血症对不良结局的预测准确性。
