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

Abstract

Background: Perinatal anemia may cause perinatal asphyxia. Its pathophysiology and neurodevelopmental effects are theoretically different from other causes of perinatal asphyxia. Objective: The study aimed to determine whether perinatal anemia results in different short-term and long-term outcomes than other causes of perinatal asphyxia treated with therapeutic hypothermia. Methods: We retrospectively included infants with moderate to severe hypoxic-ischemic encephalopathy, born between May 2009 and October 2015. During follow-up, we assessed cognitive and motor development at 2–3 years of age, using the Bayley Scales of Infant and Toddler Development, third edition (BSID-III). Neurodevelopmental outcome (NDO) was classified as abnormal in case of cerebral palsy with Gross Motor Function Classification System ≥III and/or a BSID-III composite score < 85. Outcomes of infants with perinatal anemia (initial hemoglobin < 7 mmol/L) were compared to infants born with perinatal asphyxia due to other causes. Results: In total, 111 infants were included of whom 30 infants (27%) died during the neonatal period. Infants with anemia (n = 23) had a higher mortality risk, OR 3.33, 95% CI 1.27–8.72, p = 0.01. None of the surviving infants with anemia (n = 12) had an abnormal NDO, in contrast to 26/69 (38%) with neurodevelopmental impairments, particularly motor problems, in the non-anemic group, p < 0.01. Conclusions: Perinatal anemia causing moderate to severe perinatal asphyxia is associated with a higher risk for neonatal mortality. All survivors with perinatal anemia, however, showed a normal NDO in contrast to children who were born asphyxiated due to other causes. The underlying pathophysiological mechanism for the favorable NDO in the perinatal anemia group needs further elucidation.

Prevalence and associated factors of anemia among full-term newborn babies at University of Gondar comprehensive specialized hospital, Northwest Ethiopia: a cross-sectional study

“…Due to reduced oxygen-carrying capacity; anemia has a still serious public health implication that leads to newborn morbidity and mortality [16]. A number of similar findings had been reported from different countries such as in Nigeria (28.9%) [17], in New York (21%) [18], in Brazil (32.6%) [19] and in Netherland (21%) [14] that supports our findings.…”

“…The sample size was determined using single population proportion formula by considering the following assumptions, taking 21% prevalence of anemia from the previous study done in Netherland [14], 95% confidence interval (Z = 1.96), 5% level of significance and 5% maximum allowable error (w = 0.05). Since the study population was less than 10,000, we used the correction formula.…”

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.…”

Maternal, social and health factors influencing admission of newborns to the special newborn care unit at Kakinada, India

“…A study done by Willemien et al perinatal anemia causing moderate to severe perinatal asphyxia is associated with a higher risk for neonatal mortality. 24…”