Early anemia and neonatal morbidity in extremely low birth-weight preterm infants

Rocha, Gustavo; Pereira, Sandra; Sarmento, João Antunes; Flôr-de-Lima, Filipa; Soares, Henrique; Guimarães, Hercília

doi:10.1080/14767058.2019.1689948

Cited by 17 publications

(16 citation statements)

References 30 publications

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“…Pregnancy prolongation and prenatal anaemia optimisation are pivotal in reducing neonatal morbidity. Neonatal anaemia directly correlated with severe intra/peri‐ventricular haemorrhage, with more frequent occurrence of a haemodynamically significant patent ductus arteriosus and a longer period of mechanical ventilation and ionotropic support in low‐birth‐weight premature infants 25 …”

Section: Discussionmentioning

confidence: 99%

Outcome predictors for maternal red blood cell alloimmunisation with anti‐K and anti‐D managed with intrauterine blood transfusion

et al. 2021

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Red blood cell (RBC) alloimmunisation with anti-D and anti-K comprise the majority of cases of fetal haemolytic disease requiring intrauterine red cell transfusion (IUT). Few studies have investigated which haematological parameters can predict adverse fetal or neonatal outcomes. The aim of the present study was to identify predictors of adverse outcome, including preterm birth, intrauterine fetal demise (IUFD), neonatal death (NND) and/or neonatal transfusion. We reviewed the records of all pregnancies alloimmunised with anti-K and anti-D, requiring IUT over 27 years at a quaternary fetal centre. We reviewed data for 128 pregnancies in 116 women undergoing 425 IUTs. The median gestational age (GA) at first IUT was significantly earlier for anti-K than for anti-D (24Á3 vs. 28Á7 weeks, P = 0Á004). Women with anti-K required more IUTs than women with anti-D (3Á84 vs. 3Á12 mean IUTs, P = 0Á036) and the fetal haemoglobin (Hb) at first IUT was significantly lower (51.0 vs. 70.5 g/l, P = 0Á001). The mean estimated daily decrease in Hb did not differ between the two groups. A greater number of IUTs and a slower daily decrease in Hb (g/l/day) between first and second IUTs were predictive of a longer period in utero. Earlier GA at first IUT and a shorter interval from the first IUT until delivery predicted IUFD/NND. Earlier GA and lower Hb at first IUT significantly predicted need for phototherapy and/or blood product use in the neonate. In the anti-K group, a greater number of IUTs was required in women with a higher titre. Furthermore, the higher the titre, the earlier the GA at which an IUT was required in both groups. The rate of fall in fetal Hb between IUTs decreased, as the number of transfusions increased. Our present study identified pregnancies at considerable risk of an unfavourable outcome with anti-D and anti-K RBC alloimmunisation. Identifying such patients can guide pregnancy management, facilitates patient counselling, and can optimise resource use. Prospective studies can also incorporate these characteristics, in addition to laboratory markers, to further identify and improve the outcomes of these pregnancies.

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Section: Discussionmentioning

confidence: 99%

Outcome predictors for maternal red blood cell alloimmunisation with anti‐K and anti‐D managed with intrauterine blood transfusion

et al. 2021

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“…Anaemia during the first postnatal week remained an independent significant risk factor for ROP requiring treatment. Reducing early anaemia in preterm infants may reduce their risk of developing ROP [ 6 , 38 ].…”

Section: Discussionmentioning

confidence: 99%

Effect of early prophylactic low-dose recombinant human erythropoietin on retinopathy of prematurity in very preterm infants

et al. 2020

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Background Very preterm infants are at risk of developing retinopathy of prematurity (ROP). Recombinant human erythropoietin (rhEPO) is routinely used to prevent anemia in preterm infants; however, the effect of rhEPO on ROP development is still controversial. The purpose of this study was to evaluate the effect of early prophylactic low-dose rhEPO administration on ROP development in very preterm infants. Methods A total of 1898 preterm infants born before 32 weeks of gestation were included. Preterm infants received rhEPO (n = 950; 500 U/kg, rhEPO group) or saline (n = 948, control group) intravenously within 72 h of birth and then once every other day for 2 weeks. Results The total incidence of ROP was not significantly different between the two groups (10.2% vs. 13.2%, p = 0.055). Further analysis showed that rhEPO group had lower rates of type 2 ROP than the control group (2.2% vs. 4.1%, RR 0.98; 95% CI 0.96–1.00; p = 0.021). Subgroup analysis found that rhEPO treatment significantly decreased the incidence of type 2 ROP in infant boys (1.8% vs. 4.3%, p = 0.021) and in those with a gestational age of 28–296/7 weeks (1.1% vs. 4.9%, p = 0.002) and birth weight of 1000–1499 g (1.2% vs. 4.2%, p = 0.002). There was a small increasing tendency for the incidence of ROP in infants with a gestational age of < 28 weeks after rhEPO treatment. Conclusions Repeated low-dose rhEPO administration has no significant influence on the development of ROP; however, it may be effective for type 2 ROP in infant boys or in infants with gestational age > 28 weeks and birth weight > 1500 g. Trial registration The data of this study were retrieved from two clinical studies registered ClinicalTrials.gov (NCT 02036073) on January 14, 2014, https://clinicaltrials.gov/ct2/show/NCT02036073; and (NCT03919500) on April 18, 2019. https://clinicaltrials.gov/ct2/show/NCT03919500.

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“…A platelet function analyzer (PFA-100)-based study showed that prolonged closure time (collagen-ADP > 130), a marker of impaired platelet function, is independently associated with PDA [14]. However, hematocrit differences may affect results as red blood cells play a direct role in hemostasis and anemia is an independent risk factor for PDA [24,25].…”

Section: Discussionmentioning

confidence: 99%

The Thromboelastographic Profile at Birth in Very Preterm Newborns with Patent Ductus Arteriosus

et al. 2020

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Background: The role of hemostasis in the closure of patent ductus arteriosus (PDA) in preterm infants is controversial. Objective: To assess thromboelastography (TEG) at birth in very-low-birth-weight (VLBW) infants affected by PDA. Methods: This was an ancillary study of a prospective observational study aimed at defining the TEG profile in healthy VLBW infants in the first month of life. In this analysis, we included neonates of < 33 weeks' gestational age (GA) with PDA and compared TEG traces based on (1) spontaneous closure versus the need for pharmacological treatment and (2) treatment response. We collected blood samples in the 1st day of life to perform recalcified native-blood TEG (reaction time, maximum amplitude, and lysis at 30 min [Ly30)]), standard coagulation tests, and a full blood count. Results: We enrolled 151 infants with a PDA at the first echocardiogram; 111 experienced spontaneous PDA closure while 40 required treatment. Mean GA was 29.7 ± 1.7 and 27.6 ± 2.1 weeks, and birth weight was 1,158 ± 256 and 933 ± 263 g in the 2 groups, respectively (p < 0.001). The hemostatic profile was similar between groups. Median hematocrit (44.6 and 48.7%; p = 0.01) and platelet count (187 and 216 × 10 3 /μL; p = 0.04) were lower in the treated group, although differences lost significance after controlling for GA and illness severity in the multivariate analysis. Responders to PDA treatment (n = 20) had a significantly lower median Ly30 than nonresponders (0 and 0.7%; p = 0.02). Conclusion: TEG at birth does not predict spontaneous PDA closure in preterm newborns. Fibrinolysis is enhanced in nonresponders to PDA treatment; this observation warrants further investigation.

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Early anemia and neonatal morbidity in extremely low birth-weight preterm infants

Cited by 17 publications

References 30 publications

Outcome predictors for maternal red blood cell alloimmunisation with anti‐K and anti‐D managed with intrauterine blood transfusion

Outcome predictors for maternal red blood cell alloimmunisation with anti‐K and anti‐D managed with intrauterine blood transfusion

Effect of early prophylactic low-dose recombinant human erythropoietin on retinopathy of prematurity in very preterm infants

The Thromboelastographic Profile at Birth in Very Preterm Newborns with Patent Ductus Arteriosus

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