Nonphysiological anaemia of prematurity.

Wardrop, C. A. J.; Holland, B M; Veale, K. E. A.; Jones, J.G.; Gray, O.P.

doi:10.1136/adc.53.11.855

Cited by 130 publications

(40 citation statements)

References 9 publications

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“…From our pilot experience, we suggest that a study with such an aim should enroll neonates sooner than we did. Specifically, we studied VLBW neonates who were generally 5-to 6-weeks old, corresponding closely with the expected time of their anemia of prematurity nadir, as shown by Wardrop et al 28 The fact that 19 of the 20 received no further RBC transfusions is in keeping with the observations by Wardrop et al 28 and Stockman et al 29 that once the nadir is passed, further transfusions are seldom needed. Thus, in a future transfusion avoidance study, it would be much better to enroll VLBW neonates qualifying for a transfusion during their second or third week, because avoidance of additional transfusions among these would be more likely.…”

Section: Change In Absolute Reticulocytementioning

confidence: 58%

Very low birth weight infants qualifying for a ‘late’ erythrocyte transfusion: Does giving darbepoetin along with the transfusion counteract the transfusion's erythropoietic suppression?

et al. 2011

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Objective: Red blood cell (RBC) transfusions can suppress erythropoiesis. On this basis, RBC transfusions administered to very low birth weight (VLBW) neonates potentially render them more likely to qualify for a subsequent transfusion.Study Design: We hypothesized that 'late' (>14 days after birth) RBC transfusions given to VLBW neonates result in a decrease in reticulocyte count persisting for at least 7 to 10 days. We also hypothesized that a single dose of darbepoetin given along with the transfusion would have the opposite effect, increasing the reticulocyte count for at least 7 to 10 days. To test this, we conducted a single-centered randomized trial with 20 VLBW neonates who, according to our transfusion guidelines, qualified for a late transfusion.Result: VLBW infants about to receive a late RBC transfusion were randomized (1:1) to also receive vs not receive (controls) a single subcutaneous dose of darbepoetin (10 mg kg À1 ). Reticulocyte counts diminished significantly in the controls (a drop of 85±62 Â 10 3 ml À1 (mean ± s.d.) at 7 to 10 days), but increased significantly in the darbepoetin recipients (an increase of 177±120 Â 10 3 ml À1 at 7 to 10 days, P<0.0001). At 7 to 10 days after the transfusion, hematocrits of the controls were 8.1±4.9 points above their pre-transfusion values and of the darbepoetin group were 12.4 ± 2.7 points above their pre-transfusion values (P ¼ 0.033). Conclusion:This was a limited-scope, single-centered, randomized trial intended to pilot-test a new concept in neonatal transfusion practice. Namely, we tested whether a late RBC transfusion suppressed reticulocytosis and whether a concomitant single dose of darbepoetin counteracted that suppression. Using the pilot data presented in this study, larger trials can now be designed to address meaningful clinical outcomes such as transfusion avoidance using this approach.

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Section: Change In Absolute Reticulocytementioning

confidence: 58%

Very low birth weight infants qualifying for a ‘late’ erythrocyte transfusion: Does giving darbepoetin along with the transfusion counteract the transfusion's erythropoietic suppression?

et al. 2011

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“…A decline in circulating RBCs is observed in all newborns after the first 24 h of age. In the preterm newborn, this fall is exaggerated and more rapid, to a nadir at 4-6 weeks of age [7]. However, there is no evidence in human preterm infants of a [Hb] or haematocrit threshold that results in inadequate tissue oxygenation or critical anaemia hypoxaemia.…”

Section: Anaemia Of Prematuritymentioning

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]. Outside of this indication, there is an emerging role for RBC transfusion following preterm birth as a result of its potential to favourably alter oxygen physiology thereby ameliorating hypoxic ischemic end organ (brain) injury [8].…”

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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“…Thus the premature lambs all expressed a Hb of higher than normal oxygen affinity in the perinatal period. Wardrop et al (32) described the clinical features of tachycardia, tachypnea, dyspnea, and feeding difficulties in 53% of babies born at less than 32 wk of gestation. They ascribe these findings to the high oxygen affinity of the fetal Hb in these babies.…”

Section: Post-conceptional Age (Days)mentioning

confidence: 99%

Effect of Hormone-Induced Premature Parturition on Hemoglobin Switching in Sheep

et al. 1988

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ABSTRACT. This study examines the effect of premature delivery on the switch from fetal (a2 72) to adult (a2 @2) Hb, in lambs in which premature parturition was induced by the intrafetal infusion of ACTH or corticotropin releasing hormone. Of 10 chronically cannulated ovine fetuses given ACTH at the rate of 79 ng/min for a 15 min period every 2 h starting at days 125 (n = 9) or 126 (n = 1) of gestation, three died in utero at days 131, 131, and 130, respectively. The remaining seven were born alive at 133 2 1.6 days. Five control fetuses, treated with vehicle (0.9% NaCl, wtlvol) only were delivered at 149 f 2.7 days of gestation, which is not significantly different from the duration of pregnancy in other chronically cannulated lambs in this flock. Hb switching, as measured by the globin synthesis ratio, @/a, was complete at term in the control lambs. The @/a globin synthesis ratio of the prematurely delivered lambs was not accelerated by birth, and was similar to that of control fetuses of the same gestational age still in utero. The four lambs surviving premature birth more than 70 days did not complete the switch to normal adult Hb until after 220 days postconception. (Pediatr Res 24: 688-692, 1988) Hb disappears from neonatal blood (9). It was reported that in lambs carrying the PA gene a small proportion of PC (~1 5 % of total p) appears transiently after birth and persists for several months (10). Many attempts have been made to influence the time of onset of the switch from fetal (7) to adult (P) Hb but these have been largely unsuccessful (8,9,11,12). Once commenced, the rate of the switching process has been shown to be able to be modulated. Hypophysectomy or bilateral adrenalectomy of the chronically cannulated fetus causes the completion of the switch to be delayed considerably (8, 9). In the adrenalectomized fetus replacement of cortisol in gradually increasing amounts returned the rate of adult Hb synthesis to normal (9).An increase in fetal cortisol production precedes and indeed induces parturition at normal term in sheep (13). Premature parturition can be induced by the treatment of immature ovine fetuses with cortisol, ACTH, or CRF some 3 wk or more before normal term (14, 15). These fetuses show accelerated lung maturation. The purpose of this study was to investigate the effect of premature activation of the fetal adrenal on Hb switching in the ovine fetus. The hypothesis was that premature parturition, induced by the fetal infusion of ACTH or CRF, would accelerate the completion of the switch from fetal to adult Hb. Abbreviations MATERIALS AND METHODS CRH, corticotrophin-releasing hormoneA total of 54 blood samples (1 ml) from 20 fetuses chronically cannulated as described previously (16, 17) was used to establish a, p, and 7 globin synthesis in normal intact animals from 103 days of gestation until term. Then 39 samples were collected For most of gestation sheep fetal red blood cells contain a fetal from birth until 30 days postpartum, and three samples from Hb, with two a and two 7 globi...

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Nonphysiological anaemia of prematurity.

Cited by 130 publications

References 9 publications

Very low birth weight infants qualifying for a ‘late’ erythrocyte transfusion: Does giving darbepoetin along with the transfusion counteract the transfusion's erythropoietic suppression?

Very low birth weight infants qualifying for a ‘late’ erythrocyte transfusion: Does giving darbepoetin along with the transfusion counteract the transfusion's erythropoietic suppression?

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

Effect of Hormone-Induced Premature Parturition on Hemoglobin Switching in Sheep

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