Ischemia modified albumin as a marker of hypoxia in preterm infants in the first week after birth

Martin van der Heide; Anneke C Muller Kobold; Karin K R Koerts-Steijn; Christian V Hulzebos; Jan B F Hulscher; Simon Eaton; Michael Orford; Arend F Bos; Jan Koerts; Elisabeth M W Kooi

doi:10.1016/j.earlhumdev.2023.105927

Ischemia modified albumin as a marker of hypoxia in preterm infants in the first week after birth

Early Hum Dev. 2024 Feb:189:105927. doi: 10.1016/j.earlhumdev.2023.105927. Epub 2023 Dec 30.

Affiliations

¹ University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Division of Neonatology, Groningen, the Netherlands. Electronic address: m.van.der.heide02@umcg.nl.
² University of Groningen, University Medical Center Groningen, Department of Laboratory Medicine, Groningen, the Netherlands.
³ University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Division of Neonatology, Groningen, the Netherlands.
⁴ University of Groningen, University Medical Center Groningen, Department of Surgery, Division of Pediatric Surgery, Groningen, the Netherlands.
⁵ University College London Great Ormond Street Institute of Child Health, London, UK.

PMID: 38183863
DOI: 10.1016/j.earlhumdev.2023.105927

Abstract

Background: Tissue hypoxia remains a leading cause of morbidity and mortality in preterm infants. Current biomarkers often detect irreversible hypoxic cellular injury (i.e. lactate) and are non-specific. A new biomarker is needed which detects tissue hypoxia before irreversible damage occurs.

Aims: To investigate the relation between serum ischemia modified albumin (IMA), a marker of hypoxia; and analytic variables, patient related variables and conditions associated with hypoxia, in preterm infants.

Study design: Retrospective cohort study.

Subjects: Infants with a gestational age < 30 weeks and/or birth weight < 1000 g.

Outcome measures: We collected two remnant blood samples in the first week after birth and measured IMA. IMA/albumin ratio (IMAR) was used to adjust for albumin. We assessed correlations between IMA(R) and analytic variables (albumin, lipemia- and haemolysis index); mean-2 h SpO₂; mean-2 h variability of regional splanchnic oxygen saturation (r_sSO₂), measured using near-infrared spectroscopy; and patent ductus arteriosus (PDA).

Results: Sixty-five infants were included. Albumin, the lipemia- and haemolysis index correlated negatively with IMA (r:-0.620, P<0.001; r:-0.458, P<0.001; and r:-0.337, P=0.002). IMAR correlated negatively with SpO₂ (rho:-0.614, P<0.001). Lower r_sSO₂ variability correlated with higher IMAR values (rho:-0.785, n=14, P=0.001 and rho:-0.773, n=11, P=0.005). Infants with a hemodynamic significant PDA (hsPDA) had higher IMAR values than infants without PDA (0.13 [0.11-0.28], n=16 vs. 0.11 [0.08-0.20], n=29, P=0.005 and 0.11 [0.09-0.18], n=13 vs. 0.09 [0.06-0.17], n=37, P=0.026).

Conclusions: When adjusted for albumin, the lipemia- and haemolysis index, IMAR has potential value as a marker for systemic hypoxia in preterm infants, considering the associations with SpO₂, variability of r_sSO₂, and hsPDA.

Keywords: Hypoxia; Ischemia modified albumin; Necrotizing enterocolitis; Patent ductus arteriosus; Preterm infants.

MeSH terms

Biomarkers
Ductus Arteriosus, Patent*
Hemolysis
Humans
Hyperlipidemias*
Hypoxia
Infant
Infant, Newborn
Infant, Premature
Ischemia
Retrospective Studies
Serum Albumin

Substances

Biomarkers
Serum Albumin