Hypoalbuminaemia in surgical neonates receiving parenteral nutrition

The aim of this study was to define the prevalence of hypoalbuminaemia (HA), its predisposing factors, and its effect on outcome in infants. Fifty-six consecutive infants receiving parenteral nutrition (PN) for gastrointestinal disease were divided into two groups according to their lowest measured serum albumin level. The reference range (27.9 to 50.9 g/L) for serum albumin was derived from measurements taken in 37 (22 term and 15 preterm) normal enterally fed newborn infants. HA group (serum albumin < 27.9 g/L) included 15 infants (27%); NA group (serum albumin > or = 27.9 g/L) included 41 infants (73%). HA infants received more albumin than NA infants (median 66 versus 14 mL/kg; P = .005). There was no significant difference between HA and NA groups in gestational age, postmenstrual age at time of start of PN, composition of PN, nor mean weight gain. HA was unrelated to biochemical signs of liver dysfunction, C-reactive protein elevation, septicaemic episodes, or time from operation. HA occurred within the first week of starting PN in 10 infants and returned to normal values within 5 days. HA was a recurrent phenomenon in three patients. Mortality was higher in the HA group (33.3%) than in the NA group (4.9%; P = .02) but was apparently causally unrelated to the low serum albumin level. Hypoalbuminaemia is a common finding in neonates on PN despite the administration of exogenous albumin. Monitoring serum albumin levels in surgical infants on PN seems to be of little clinical value.