Neonatal clinical blood sampling led to major blood loss and was associated with bronchopulmonary dysplasia

Martinsson

Arch Dis Child Fetal Neonatal Ed

et al. 2020

Self Cite

ObjectiveEarly decrease in fetal haemoglobin (HbF) is an indicator of loss of endogenous blood components that might have predictive value for development of bronchopulmonary dysplasia (BPD). The link between HbF and BPD has not been evaluated.DesignRetrospective observational study.SettingTertiary level neonatal intensive care unit, referral centre for Southern Sweden.Patients452 very preterm infants (<30 gestational weeks) born 2009–2015.InterventionsRegular clinical practice.Main outcome measuresMean HbF, haemoglobin (Hb) and partial oxygen pressure (PaO2) levels calculated from 11 861 arterial blood gas analyses postnatal week 1. Relationship between HbF (%) and BPD (requirement of supplemental oxygen at 36 weeks’ postmenstrual age) and the modifying influence of PaO2 (kPa) and total Hb (g/L) was evaluated.ResultsThe mean gestational age (GA) at birth was 26.4 weeks, and 213 (56%) infants developed BPD. A 10% increase in HbF was associated with a decreased prevalence of BPD, OR 0.64 (95% CI 0.49 to 0.83; p<0.001). This association remained when adjusting for mean PaO2 and Hb. Infants with an HbF in the lowest quartile had an OR of 27.1 (95% CI 11.6 to 63.4; p<0.001) for development of BPD as compared with those in the highest quartile. The area under the curve for HbF levels and development of BPD in the full statistical model was 0.871.ConclusionsEarly rapid postnatal decline in HbF levels was associated with development of BPD in very preterm infants. The association between HbF and BPD was not mediated by increased oxygen exposure. The potential benefit of minimising loss of endogenous blood components on BPD outcome will be investigated in a multicentre randomised trial.

Section: Discussionmentioning

confidence: 54%

Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

“…Of note, sample-related blood volume loss during the first postnatal week was associated with development of bronchopulmonary dysplasia (BPD). 5 …”

Section: Introductionmentioning

confidence: 99%

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Fetal haemoglobin and bronchopulmonary dysplasia in neonates: an observational study

Martinsson

Arch Dis Child Fetal Neonatal Ed

et al. 2020

Self Cite

“…In our study, for each additional gram of Hb upon KMCP admission, oxygen dependency would decrease by 1.8 days and for each transfusion received, 4.8 more days of oxygen would be required. In this regard, Hellstrom et al, in a retrospective cohort study with records of 149 extremely premature babies born in Sweden between 2013 and 2018, found that blood sampling produced a 58% depletion of blood volume between days 1-14, which was correlated with the number of adult blood transfusions (r=0.87); blood loss from sampling during the first 7 days of life was related to higher BPD (adjusted OR 2.4; 95% CI 1.1-5.4) 30 . Similarly, Duan et al in a prospective cohort with 243 children <32 weeks GA in China, found early anemia significantly associated with the development of BPD (adjusted OR 4.89; 95% CI 1.57 -15.26) 31 .…”

Section: Discussionmentioning

confidence: 99%

Anemia, nutrition and ambulatory oxygen weaning in a cohort of oxygen-dependent premature infants.

Montealegre‐Pomar

Charpak²

2020

Preprint

Background: In Bogotá, Colombia, oxygen-dependent (OD) preterm infants are home discharged in Kangaroo Position, to a Kangaroo Mother Care program (KMCP) with ambulatory oxygen, strict follow-up and oxygen weaning protocols. Objectives: 1) to describe growth and morbimortality up to 6 months of an OD preterm infants’ cohort. 2) to explore the association between oxygen requirement, perinatal history, Hb levels, transfusions, feeding patterns and growth. Methods: Prospective cohort study. Descriptive and multivariate analysis. Results: 445 patients were recruited with 33 weeks median gestational age (GA). 21% of mothers had preeclampsia, 50% infections and 77% received antenatal corticosteroids. Upon KMCP admission, median GA, chronological age and hospital stay were 36 weeks, 19 and 17 days, respectively; 55.6% of patients had neonatal sepsis and 66.6% were admitted to Neonatal Intensive Care Unit. Patients had on average 52 days with oxygen, a median of 3200g and 42 weeks GA at oxygen weaning. Median follow-up oxygen saturation was 94% with 0.016-0.5 l/min of oxygen. One-year mortality was 0.2% and attrition 20%. At 6 months, all patients had appropriate growth and 66% were breastfeeding. Multiple regression analysis showed that higher GA, Hb levels, weight gain, and exclusive breastfeeding decreased oxygen requirement whilst invasive ventilation and transfusions had the opposite effect (R2=0.48). Conclusions: In OD preterm infants, there is a close relationship between days of oxygen requirement and GA, mechanical ventilation, Hb levels at discharge, transfusions, exclusive breastfeeding and weight gain. Strict monitoring with established protocols in an ambulatory KMCP allows adequate growth and safe oxygen weaning.

Anemia, nutrition, and ambulatory oxygen weaning in a cohort of oxygen‐dependent premature infants

Montealegre‐Pomar

Charpak

2021

Pediatric Pulmonology

Background: In Bogotá, Colombia, oxygen-dependent (OD) preterm infants are home discharged in Kangaroo Position, to a Kangaroo Mother Care Program (KMCP) with ambulatory oxygen, strict follow-up, and oxygen weaning protocols. Objectives:(1) To describe growth, morbimortality, and oxygen monitoring up to 6 months in OD preterm infants. (2) To explore associations between oxygen weaning, perinatal history, Hb levels, transfusions, feeding patterns, and growth.Methods: A prospective cohort study. Descriptive and multivariate analysis.Results: Recruited patients were 407 with 33 weeks median gestational age (GA).Mothers presented infections >28%, pre-eclampsia in 22%, and 80% received antenatal corticosteroids. Upon KMCP admission, median GA, chronological age, and hospital stay were 36 weeks, 21 and 17 days, respectively; 56.8% of patients had neonatal sepsis and 67.8% were admitted to the neonatal intensive care unit. At oxygen weaning, patients had a median of 54 days with oxygen, median weight 3240 g and GA 41 weeks. Median follow-up oxygen saturation was 94% with 1/64-1/2 L/min of oxygen. One-year mortality was 0.2% and attrition 20%. At 6 months, all patients had appropriate growth and 67% were breastfeeding.Multiple regression analysis showed that higher GA, Hb levels, weight gain, and exclusive breastfeeding decreased oxygen requirement while invasive ventilation and transfusions had the opposite effect (R 2 = .49). Conclusions:In OD preterm infants, there is a close relationship between days of oxygen requirement and GA, mechanical ventilation, Hb levels at discharge, transfusions, exclusive breastfeeding, and weight gain. Strict monitoring with established protocols in an ambulatory KMCP allows adequate growth and safe oxygen weaning.