Aosong Yu,1 Huanhuan Hou,2 Danhua Shi,1 Wanchun Xin,1 Lingyi Ran,1 Xiaojia Sun,1 Zihui Sun,3 Yijin Li,3 Tong Feng1 

1Department of Pediatrics, Dandong Central Hospital, China Medical University, Dandong, People’s Republic of China; 2School of Clinical Medicine, Xinjiang Medical University, Urumqi, People’s Republic of China; 3Department of Pediatrics, Dandong Central Hospital, Dalian Medical University, Dandong, People’s Republic of China

Correspondence: Tong Feng, Department of Pediatrics, Dandong Central Hospital, China Medical University, No. 338 Jinshan Street, Zhenxing District, Dandong, Liaoning Province, 118002, People’s Republic of China, Email Tongfeng0177@163.com

Objective: This study aims to investigate the relationship between serum albumin levels and neonatal acute respiratory distress syndrome (NARDS) in patients with newborn pneumonia, providing new insights for clinical interventions targeting NARDS.
Methods: A retrospective analysis of medical records of neonatal pneumonia patients admitted to the neonatal intensive care unit (NICU) at a tertiary medical institution from January 2021 to December 2023 was conducted. Patients were stratified based on hypoalbuminemia (defined as serum albumin levels < 35 g/L), clinical thresholds, and albumin level quartiles. To eliminate the impact of potential confounding factors on the results, multivariable logistic regression and propensity score matching (PSM) analyses were performed to calculate the adjusted odds ratio (OR) and 95% confidence interval (95% CI) for the occurrence of NARDS in these patients. Additionally, subgroup analyses were conducted to explore interaction effects.
Results: In this retrospective cohort study, a total of 342 patients with neonatal pneumonia admitted to the NICU were included. The multivariable logistic regression analysis revealed that the incidence of NARDS in patients with hypoalbuminemia was significantly higher than in those with normal albumin levels (OR = 2.16, 95% CI 1.47– 4.06, p = 0.017). Compared to patients in quartile Q1 (≥ 39 g/L), those in quartile Q4 (≤ 33 g/L) exhibited a significantly increased risk of NARDS (OR = 4.40, 95% CI 1.53– 12.63, p = 0.006). After conducting PSM, these associations remained significant. Furthermore, treating serum albumin levels as a continuous variable revealed that each 1 g/L increase was associated with a 17% reduction in NARDS risk (95% CI, 1.08– 1.15).
Conclusion: Low serum albumin levels in patients with neonatal pneumonia are closely associated with NARDS, indicating a significant dose-response relationship between the two.

Keywords: neonatal, newborn pneumoniae, neonatal acute respiratory distress syndrome, albumin, hypoalbuminemia