Severe Anemia at Birth—Incidence and Implications

Bahr, Timothy M.; Lawrence, Shelley M.; Henry, Erick; Ohls, Robin K.; Li, Shihao; Christensen, Robert D.

doi:10.1016/j.jpeds.2022.05.045

Cited by 4 publications

(8 citation statements)

References 21 publications

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“…As shown in Figure 1, among the 707 that had a cord hemoglobin reported, fetal/neonatal anemia was diagnosed in 83 (12%) (defined as a hemoglobin below the fifth percentile lower reference interval for gestational age), and severe anemia (defined as below the first percentile) was diagnosed in 16 (2%). 3 Of those with a confirmed abruption, 9% (63/678) had anemia at birth. Of those who did not have an abruption, 6% had anemia at birth (p = 0.049).…”

Section: Resultsmentioning

confidence: 99%

“…1 In addition to that recommendation, at Intermountain Health we request that a hemoglobin measurement be obtained with every umbilical cord gas, as a means of rapidly identifying anemia at birth, among these high-risk neonates. [2][3][4] We were uncertain how frequently both an umbilical arterial and a venous blood gas, each with a hemoglobin level, are successfully being drawn and reported at our high-risk deliveries. In actual practice, the implementation of recommendations is virtually always incomplete, because barriers to full implementation exist.…”

Section: Introductionmentioning

confidence: 99%

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Evaluating Practice Consistency: Complying with the Directive to Obtain Umbilical Cord Arterial and Venous Blood Gasses, and Hemoglobin Values, at High-risk Deliveries

Christensen,

Bahr,

Tweddell

et al. 2024

Newborn

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Introduction:Using Intermountain Health multihospital data, we quantified compliance with the American College of Obstetricians and Gynecologists directive to obtain umbilical cord arterial and venous blood gasses at high-risk deliveries. We also quantified compliance with our local directive to obtain hemoglobin with the cord gasses as an early screen for anemia. Methods: Retrospective 24-month analysis of Intermountain Health deliveries. Results: One-thousand-fifty births had "placental abruption" mentioned in the peripartum notes. These constituted our high-risk delivery study cohort. Of these, 726 (69%) had both a cord arterial and venous sample reported; 707 (67%) also had hemoglobin reported. In 86 (8%) only one (arterial or venous) was reported, and 293 (23%) had neither gasses nor hemoglobin. One-hundred-seven of the 726 had acidosis (cord arterial pH <7.13) and 619 did not (pH ≥7.13). Among those with acidosis, 82 had abruption confirmed after birth; in 25 abruption was not confirmed. Paired umbilical arterial vs venous hemoglobin levels revealed the novel observation that umbilical venous hemoglobin is slightly lower than arterial (p < 0.0001), perhaps due to maternal-to-fetal acellular fluid transfer. Among the 707 that had cord hemoglobin reported, fetal/neonatal anemia was diagnosed in 83 (12%) (defined as hemoglobin below the fifth percentile lower reference interval for gestational age). Conclusions: We see an opportunity to improve compliance with the directives to obtain cord arterial and venous blood gas and hemoglobin at high-risk births. Doing so will allow rapid evaluation of about 30% more high-risk infants for the presence of acidosis and anemia at birth.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Evaluating Practice Consistency: Complying with the Directive to Obtain Umbilical Cord Arterial and Venous Blood Gasses, and Hemoglobin Values, at High-risk Deliveries

Christensen,

Bahr,

Tweddell

et al. 2024

Newborn

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“…Therefore, placental abruption typically causes maternal morbidity due to blood loss, but the fetal morbidity it causes is typically from hypoxia/ischemia. However, sometimes a neonate has anemia at birth with no explanation for the anemia other than placental abruption (13). In such situations did the abruption result in fetal blood loss and cause the neonatal anemia?…”

Section: Discussionmentioning

confidence: 99%

“…A plausible cause for the anemia was identi ed in 176/344 (51%); 129 of these (73%) were the result of hemorrhage, 48 were associated with placental abruption, 44 were due to fetomaternal hemorrhage, 15 twin-twin transfusion, 10 internal hemorrhage (not subgaleal), three subgaleal hemorrhage, and nine other various hemorrhages. We concluded that severe anemia at birth is rare, but when found, it is usually the result of fetal hemorrhage, the most common association being with placental abruption (13).…”

Section: Introductionmentioning

confidence: 88%

“…Another way to investigate whether abruption can cause neonatal anemia is to study neonates who have severe anemia diagnosed within a few hours after birth and determine how many of those had a placental abruption identi ed as the only recognized cause of that anemia. We recently took that approach (13), reporting that during a 10-year period in our multi-hospital healthcare system, 344 neonates were identi ed with severe anemia in the rst six hours after birth. A plausible cause for the anemia was identi ed in 176/344 (51%); 129 of these (73%) were the result of hemorrhage, 48 were associated with placental abruption, 44 were due to fetomaternal hemorrhage, 15 twin-twin transfusion, 10 internal hemorrhage (not subgaleal), three subgaleal hemorrhage, and nine other various hemorrhages.…”

Section: Introductionmentioning

confidence: 99%

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Placental abruption and neonatal anemia

et al. 2023

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Placental abruption can cause maternal blood loss and maternal anemia. It is less certain whether abruption can cause fetal blood loss and neonatal anemia. STUDY DESIGN:Retrospective multi-hospital 24-month analysis of women with placental abruption and their neonates. RESULTSOf 55 111 births, 678 (1.2%) had con rmed abruption; 83% of these neonates (564) had one or more hemoglobins recorded in the rst 24 hours. Four-hundred-seventy-two (83.7%) had a normal hemoglobin (≥ 5th % reference interval) while 92 (16.3%) had anemia, relative risk 3.26 (95% CI, 2.66-4.01) vs. >360 000 neonates from previous reference interval reports. The relative risk of severe anemia (< 1st % interval) was 4. 96 (3.44-7.16). When the obstetrician identi ed the abruption as "small" or "marginal" the risk of anemia was insigni cant. CONCLUSIONSMost abruptions do not cause neonatal anemia but approximately 16% do. If an abruption is not documented as small, it is important to surveille the neonate for anemia.

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Diagnosing Anemia in Neonates: An Evidence-Based Approach

et al. 2023

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It is important for clinicians who render neonatal care to precisely and reproducibly diagnose anemia; however, confusion arises from various definitions. For the simplicity and consistency of detection, we advocate defining neonatal anemia as a hemoglobin level or hematocrit below the 5th percentile of the reference population, which is highly dependent on gestational and postnatal ages. Thus, a newborn infant delivered at 24 weeks’ gestation will have anemia with a blood hemoglobin concentration much lower than a hemoglobin concentration defining anemia at term. Moreover, a hemoglobin concentration defining anemia at term birth is higher than that defining anemia in the same infant 60 days after birth. Diagnosing neonatal anemia can be evidence-based and consistent by using reference intervals derived from large neonatal databases. To do this, we advocate defining anemia as a hemoglobin level that plots below the 5th percentile lower reference interval, defining moderately severe anemia as a hemoglobin value between the 1st and 5th percentile, and defining severe anemia as a hemoglobin level that plots below the 1st percentile. The information provided in this review can easily be adopted by clinical laboratories and individual neonatal care units, thereby fostering application of these definitions for all infants whose hemoglobin levels are measured. Additional normative values included in this review describing various other erythrocyte metrics can likewise be easily adopted. Doing so will codify and standardize the diagnosis of neonatal anemia and will facilitate identifying the cause of the anemia, thus pointing the way to proper additional diagnostic testing and treatment.

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Severe Anemia at Birth—Incidence and Implications

Cited by 4 publications

References 21 publications

Evaluating Practice Consistency: Complying with the Directive to Obtain Umbilical Cord Arterial and Venous Blood Gasses, and Hemoglobin Values, at High-risk Deliveries

Evaluating Practice Consistency: Complying with the Directive to Obtain Umbilical Cord Arterial and Venous Blood Gasses, and Hemoglobin Values, at High-risk Deliveries

Placental abruption and neonatal anemia

Diagnosing Anemia in Neonates: An Evidence-Based Approach

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