Low Plasma Protein Levels at Birth Are Associated with Poor Cardiovascular Adaptation and Serious Adverse Outcome in Infants with Gestational Age <32 Weeks: The ProHémie Study.
BACKGROUND
Retrospective studies suggest that early hypoproteinemia has prognostic value for adverse outcome in preemies, but the underlying pathophysiology is unknown. We hypothesized that the prognostic relevance of hypoproteinemia could be related to its association with impaired cardiovascular function and organ perfusion during transition.


OBJECTIVES
To describe the plasma protein status and the measures of cardiovascular function according to the outcome in infants <32 weeks' gestation.


METHODS
One hundred and twenty-eight infants were prospectively included from birth to discharge. During the first 24 h of life, we assessed the cardiovascular function and systemic and organ blood flow by Doppler ultrasound, and monitored cerebral and renal regional oxygen saturation (cRSO2, rRSO2) using near-infrared spectroscopy. These measures were analyzed in relationship to hypoproteinemia (total plasma protein level <40 g/L at 12 h of life) and severe adverse outcome (death or survival with severe neurological injury).


RESULTS
Hypoproteinemia was associated with a higher risk of a severe adverse outcome after adjustment of confounding variables (adjusted OR = 6.8; 95% CI 1.3-34). Compared to normoproteinemic infants and after adjustment for gestational age, hypoproteinemic ones had more significantly: hypotension (7 vs. 13%, p = 0.03), abnormal capillary refilling time (20 vs. 36%, p < 0.001), abnormal renal blood flow (resistive index 0.78 ± 0.11 vs. 0.85 ± 0.09, p = 0.04), lower rRSO2 (82.9 ± 9.2 vs. 73.6 ± 10.5%, p = 0.04), and lower systemic vascular resistance (0.155 ± 0.058 vs. 0.108 ± 0.037 mm Hg/L/kg; p = 0.04). The cRSO2 patterns were significantly decreased in infants with severe adverse outcome and independent from protein status.


CONCLUSION
Hypoproteinemia is associated with impaired cardiovascular function. Further studies are required to elucidate the interplay between changes in protein levels, postnatal hemodynamics and clinical outcome.
['Bonsante|Francesco|F|', 'Ramful|Duksha|D|', 'Samperiz|Sylvain|S|', 'Daniel|Sandrine|S|', 'Godeluck|Anais|A|', 'Robillard|Pierre-Yves|PY|', 'Jamal-Bey|Karim|K|', 'Gouyon|Jean-Bernard|JB|', 'Binquet|Christine|C|', 'Iacobelli|Silvia|S|']
D000222:Adaptation, Physiological D015415:Biomarkers D001798:Blood Proteins D002318:Cardiovascular Diseases D002319:Cardiovascular System D016009:Chi-Square Distribution D015150:Echocardiography, Doppler D005260:Female D005865:Gestational Age D006439:Hemodynamics D006801:Humans D007019:Hypoproteinemia D062071:Infant, Extremely Premature D007231:Infant, Newborn D007234:Infant, Premature D016014:Linear Models D016015:Logistic Models D008297:Male D016017:Odds Ratio D011446:Prospective Studies D012039:Regional Blood Flow D012307:Risk Factors D019265:Spectroscopy, Near-Infrared D013997:Time Factors D016277:Ventricular Function, Left
Albumin Arterial blood pressure Neonatal intensive care Neurological outcome Peripheral circulation Postnatal adaptation Prognosis Renal function Very-low-birth-weight infants