Severe Neonatal Anaemia, MRI Findings and Neurodevelopmental Outcome

Abstract

Background and Objective: Severe neonatal anaemia can impair cerebral oxygen supply. Data on long-term outcomes following severe neonatal anaemia are scarce. Methods: Clinical data and neurodevelopmental outcome of 49 (near) term infants with haemoglobin concentration after birth <6.0 mmol/l were retrospectively collected and analysed. In a subgroup of 28 patients, amplitude-integrated EEG was available and in 25 infants cerebral MRI was obtained. Infants were followed up at 14-35 months of age and assessed with the Griffiths Scale of Mental Development or Bayley Scale of Infant Development. Results: Eighteen patients (37%) died during the neonatal period. In 25 patients MRI was performed. A predominant pattern of injury on MRI was seen in the basal ganglia and thalami in 7 patients (28%), whereas some form of white matter injury was present in 16 (64%) and a combination in 3 (12%). Follow-up data were available for 26 patients (84% of survivors). Formal assessment of neurodevelopmental outcome was performed in 20 of 31 (65%) infants who survived (median age: 19 months, range: 14-35). Sixteen infants (80%) had a developmental quotient appropriate for age in the first 2 years after birth. On motor outcome, 1 patient (5%) scored below average (Z-score -1.10). One patient developed cerebral palsy. Conclusion: Early neurodevelopmental outcome in surviving patients with severe neonatal anaemia was within the normal range in the majority of the survivors. MRI showed mild-to-moderate white matter injury in two thirds of the infants. Prospectively collected data with a longer follow-up period are needed.

Perinatal Anemia is Associated with Neonatal and Neurodevelopmental Outcomes in Infants with Moderate to Severe Perinatal Asphyxia

“…Moreover, they did not report their rate of mortality, which may also have accounted for differences between their and our results. In line with our results, Zonnenberg et al [13] showed normal NDOs in all surviving infants born with anemia and they suggested that neonatal anemia itself did not significantly affect the long-term outcome. Neurodevelopmental tests, however, were not routinely performed in their study.…”

“…Third, the cut-off value of 7 mmol/L that we chose to define perinatal anemia may also account for these positive results, because it was slightly higher compared with other studies [13,14]. The anemic group may comprise some infants who did not suffer from severe perinatal anemia.…”

“…In a study performed between 2000 and 2011, 18 (37%) severely anemic patients died within 72 h after birth [13]. Muraskas et al [14] also reported higher mortality rates in infants with perinatal anemia leading to birth asphyxia.…”

Predictors of Long-Term Neurodevelopmental Outcome of Hypoxic-Ischemic Encephalopathy Treated with Therapeutic Hypothermia

“…Perinatal anemia causing HIE has been associated with higher neonatal mortality. 60,61 However, survivors of severe perinatal anemia have been also described to have reassuring neurodevelopmental outcomes at 2 to 3 years of age. 60,61 In summary, there are only limited data available on the prognostic value of biochemical parameters on neurodevelopmental outcomes.…”

Effects and safety of delayed versus early umbilical cord clamping in newborns of HIV-infected mothers

“…Prenatal iron deficiency affects the normal development of brain structures, neurotransmitter systems and myelination [12]; therefore, anaemia and iron deficiency are largely demonstrated to be associated with impaired psychomotor development, impaired performance in language tests, and in motor and coordination skills [13][14][15]. DCC performed in the first minutes after birth, allows newborn, either to anaemic and nonanaemic mothers, to receive a substantial blood transfusion from placenta and increase blood volume of an average 32%, leading to obtain higher birthweight and haemoglobin concentration [8].…”