Anaemia of prematurity: Pathophysiology and treatment

Strauss, Ronald G.

doi:10.1016/j.blre.2010.08.001

Cited by 154 publications

(134 citation statements)

References 40 publications

(61 reference statements)

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“…Furthermore, physiologic anemia peaks at ∼10 weeks of age in term infants with the nadir in Hb being more severe and earlier in onset in preterm infants. 53 Anemia is associated with reduced cerebral TOI because of increased oxygen extraction necessitated by a reduced oxygen carrying capacity. 54 Although Hb was not measured in our study, it is likely that Hb concentrations would be relatively low at 2 to 3 months CA, contributing to reduced cerebral TOI.…”

Section: Effects Of Postterm Camentioning

confidence: 99%

“…22 Impaired oxygen carrying capacity because of anemia, which is likely to be more severe in preterm infants, as mentioned previously, may contribute to this mismatch. 53 Furthermore, it is well established that prematurity and a period of neonatal intensive care can result in altered brain maturation as evidenced by MRI studies at term-equivalent age assessing cerebral volumes, 60,61 cortical folding, 62 and neural networks. 63 Although few data exist on brain development in preterm infants after term-equivalent age, we suggest that the preterm infant brain undergoes significant "catch-up" growth resulting in an increased cerebral metabolic rate for oxygen compared with term infants, a maturational difference that appears to resolve by 5 to 6 months CA.…”

Section: Effects Of Preterm Birthmentioning

confidence: 99%

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Cerebral Oxygenation in Preterm Infants

et al. 2014

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BACKGROUND AND OBJECTIVE: Prone sleeping is a major risk factor for sudden infant death syndrome (SIDS) and preterm infants are at significantly increased risk. In term infants, prone sleeping is associated with reduced mean arterial pressure (MAP) and cerebral tissue oxygenation index (TOI). However, little is known about the effects of sleeping position on TOI and MAP in preterm infants. We aimed to examine TOI and MAP in preterm infants after term-equivalent age, during the period of greatest SIDS risk. METHODS: Thirty-five preterm and 17 term infants underwent daytime polysomnography, including measurement of TOI (NIRO-200 spectrophotometer, Hamamatsu Photonics KK, Japan) and MAP (Finapress Medical Systems, Amsterdam, Netherlands) at 2 to 4 weeks, 2 to 3 months, and 5 to 6 months postterm age. Infants slept prone and supine in active and quiet sleep. The effects of sleep state and position were determined by using 2-way repeated measures analysis of variance and of preterm birth by using 2-way analysis of variance. RESULTS: In preterm infants, TOI was significantly lower when prone compared with supine in both sleep states at all ages (P < .05). Notably, TOI was significantly lower in preterm compared with term infants at 2 to 4 weeks, in both positions (P < .05), and at 2 to 3 months when prone (P < .001), in both sleep states. MAP was also lower in preterm infants in the prone position at 2 to 3 months (P < .01). CONCLUSIONS: Cerebral oxygenation is reduced in the prone position in preterm infants and is lower compared with age-matched term infants, predominantly in the prone position when MAP is also reduced. This may contribute to their increased SIDS risk.

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Section: Effects Of Postterm Camentioning

confidence: 99%

Section: Effects Of Preterm Birthmentioning

confidence: 99%

Cerebral Oxygenation in Preterm Infants

et al. 2014

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“…The conventional model of RBC transfusion includes a transfusion algorithm based on either [Hb] or haematocrit, modified by chronologic age and need for respiratory support [3,4,6]. This model of transfusion practice has been studied in randomised trials in preterm infants.…”

Section: Conventional Model Of Transfusion Practice In Preterm Infantsmentioning

confidence: 99%

“…This condition is defined by significant anaemia in the con text of phlebo tom y b lood lo sses, lower erythropoietin (EPO) (hepatic versus renal) production and a limited bone marrow response [6]. It represents a pathologic extreme of physiologic anaemia in a high-risk population of preterm infants and is the commonest reason for transfusion in the nursery [7].…”

Section: Introductionmentioning

confidence: 99%

Anaemia in the Premature Infant and Red Blood Cell Transfusion: New Approaches to an Age-Old Problem

Andersen

Keir

Kirpalani

et al. 2015

Curr Treat Options Peds

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Opinion statementRed blood cell (RBC) transfusion is a common intervention in very preterm infants with variable utilisation between centres and individual clinicians. This variation likely reflects uncertainty about who, when and how much to transfuse. Most RBC transfusions are given in small volumes as "top-up" for anaemia or cumulative phlebotomy loss. Whilst the newly born infant may have a low haemoglobin (Hb) value, it is uncertain if this is of clinical or physiologic significance except at extreme values. Little attention has been given to the potentially favourable effect of RBC transfusion on oxygen kinetics, particularly in the interval after birth when the risk of hypoxic ischaemia is high. Later anaemia, at the time of likely Hb nadir, more typifies anaemia of prematurity. In this article, we will firstly review the conventional model of RBC transfusion based on haemoglobin [Hb] thresholds and secondly, we will propose an alternate, individualised, practice based on the oxygen physiology. This effectively reframes the potential role of RBC transfusion in the very preterm infant and demands a new generation of clinical trials.

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“…1 Anemia is also a common complication. 2 The cause of such complications is multifactorial and includes a hypoxic state, organ ischemia, and a broad-spectrum inability to adapt to the extrauterine environment. 3 Importantly, the risk of acute neonatal illnesses decreases with gestational age, reflecting the fragility and immaturity of vital organs in premature neonates.…”

Section: Introductionmentioning

confidence: 99%

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2015

Exp Clin Transplant

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Objectives: This is a preliminary, single-center, prospective study in the field of autologous cord blood transplant. We investigated the feasibility, safety, and tolerability of autologous whole cord blood transplant in extremely premature infants as a potential therapeutic modality to prevent developing complications related to prematurity. Materials and Methods: This preliminary prospective study (ClinicalTrials.gov identifier NCT02050971) included preterm infants born at less than 32 weeks of gestational age who developed anemia because of prematurity. Infants were assigned to 2 groups: (1) those receiving an autologous cord blood transfusion within 5 days postpartum (n = 5) and (2) those who obtained only an allogeneic red blood cell transfusion when necessary (n = 9; control group). Vital measurements were performed during and after transfusion, and peripheral blood pH, hematocrit, glucose, and calcium and potassium ion levels were measured over the next 4 days. Results: Oxygen saturation was significantly increased throughout the cord blood transfusion and in the subsequent 48 hours. No significant differences were found in vital measurements, such as arterial blood pressure (mean, systolic, and diastolic) or heart rate over the first 48 hours posttransfusion. Similarly, no significant differences were found in biochemical analyses of blood with the exception of pH level. We found initial pH level to be significantly augmented in the cord blood recipient group by the first day after transplant, which remained significantly higher for next 24 hours compared with that shown in the control group. Conclusions: Collection, preparation, and short-term storage of unfrozen cord blood are feasible for clinical use. Our results showed general safety and tolerability of the procedure of whole autologous cord blood transplant in recruited preterm newborns. However, because our study group was small, these results need to be confirmed in further investigations with a larger patient cohort.

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Anaemia of prematurity: Pathophysiology and treatment

Cited by 154 publications

References 40 publications

Cerebral Oxygenation in Preterm Infants

Cerebral Oxygenation in Preterm Infants

Anaemia in the Premature Infant and Red Blood Cell Transfusion: New Approaches to an Age-Old Problem

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