Severe neonatal anemia from fetomaternal hemorrhage: report from a multihospital health-care system

Christensen, Robert D.; Lambert, D K; Baer, Vickie L.; Richards, Douglas; Bennett, Sterling T.; Ilstrup, Sarah J.; Henry, Erick

doi:10.1038/jp.2012.142

Cited by 43 publications

(45 citation statements)

References 21 publications

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“…[5,12] However, even mild anemia in infancy has documented clinical significance including poor growth and cognitive deficit. [13] Despite these consequences and a suggested recent rise in incidence of severe FMH,[9] early predictors of FMH remain unknown and no cause of hemorrhage can be identified in over 80% of cases.…”

Section: Discussionmentioning

confidence: 99%

Impact of Physician Awareness on Diagnosis of Fetomaternal Hemorrhage

Stroustrup¹,

Plafkin

Savitz³

2014

Neonatology

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Background: Fetomaternal hemorrhage (FMH) is a poorly understood condition in which the placenta allows transmission of fetal whole blood to the mother. FMH can cause fetal anemia resulting in critical illness, death or lifelong disability. Ascertainment of the incidence of FMH is limited by reliance on retrospective studies that are dependent on a diagnosis of FMH being made at the time of patient presentation. Objective: To determine whether the diagnosis of FMH is made more frequently after an educational intervention to increase physician awareness of the condition. Methods: This is a retrospective cohort study of all neonates born at our institution from 1988 through 2010. The medical records of all neonates diagnosed with anemia in the first 24 h of life were reviewed. The incidence of FMH as a documented etiology of anemia was compared between infants born before and after our educational intervention. Results: Of 124,738 births during the study period, 572 neonates with neonatal anemia were identified. A total of 23 cases of FMH demonstrated by positive Kleihauer-Betke testing occurred in our cohort. The incidence of diagnosed FMH prior to our intervention was 22 per 1,000 anemic neonates compared to 182 per 1,000 afterwards (p < 0.001), while the incidence of neonatal anemia remained unchanged (p = 0.377). Conclusions: FMH may be a significant cause of neonatal anemia. Diagnosis of FMH is highly dependent on physician awareness of the condition. Incorrect or absent diagnosis of the etiology of neonatal anemia has significant implications for our understanding of the epidemiology of FMH.

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Section: Discussionmentioning

confidence: 99%

Impact of Physician Awareness on Diagnosis of Fetomaternal Hemorrhage

Stroustrup¹,

Plafkin

Savitz³

2014

Neonatology

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“…Although the majority of these pregnancies have a favorable outcome, it may be the first sign of impending fetal death or massive FMH. Despite the existence of known risk for FMH, it presents usually with nonspecific symptoms and signs such as DAFM, SHR, fetal hydrops or stillbirth [5], or early neonatal anemia [21]. If the perception of DAFM persists, consideration should be given to other causes such as fetal structural anomalies (4.3%), anemia or FMH.…”

Section: Management Of Pregnancies With Suspicion Of Clinically Relevmentioning

confidence: 99%

“…Christensen et al [21] have performed multicentered data-based study on 219 853 live births and identified all anemic neonates with either hematocrit less than 30% or hemoglobin less than 10 g/dl on the day of birth, who had laboratory-based…”

Section: Massive Fetomaternal Hemorrhagementioning

confidence: 99%

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Fetomaternal hemorrhage complicated pregnancy

Stefanović

2016

Current Opinion in Obstetrics &Amp; Gynecology

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“…Retrospective studies in large populations document an incidence of FMH diagnosis of 1–2/10,000 live births. [4, 5, 10] The true incidence of clinically significant FMH is likely much higher, however, as FMH testing is underutilized in clinical practice. [4, 5, 11] Currently, testing for FMH after live birth occurs when significant fetal or neonatal anemia or is recognized.…”

Section: Introductionmentioning

confidence: 99%

Demographic and Behavioral Predictors of Severe Fetomaternal Hemorrhage: A Case-Control Study

Stroustrup

Plafkin²,

Tran³

et al. 2016

Neonatology

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Background: Fetomaternal hemorrhage (FMH) signifies failure of the placental barrier with whole blood transfer. Fetal anemia following FMH is associated with significant morbidity and mortality. If FMH is identified early, fetal anemia can be treated to minimize adverse outcomes. Risk factors for FMH are not known, limiting efforts to provide targeted screening for FMH. Objective: To identify maternal and/or pregnancy characteristics associated with FMH that are recognizable prior to fetal morbidity. Methods: This is the first published case-control study of FMH. Cases were identified from a prospectively maintained database of all hospital births between 1988 and 2010. Each case was matched to 4 controls by date and time of birth, allowing for assessment of a wide range of clinical and demographic data. Logistic regression modeling was used to assess the association between demographic and clinical characteristics and the diagnosis of FMH. Results: A total of 23 mother-baby pairs impacted by FMH and 92 matched controls were evaluated. Compared to controls, case mothers were more likely to have private insurance and to work outside the home and at night during pregnancy. Cases were more likely to be delivered preterm, but preterm labor was not more common among cases. There was no difference in race/ethnicity of cases compared to controls. Conclusions: Severe FMH is associated with significant morbidity and mortality of the affected neonate. Women with FMH were more likely to work outside the home during pregnancy than women with normal pregnancies. This finding has implications for third-trimester screening of pregnant women who work in strenuous fields.

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Severe neonatal anemia from fetomaternal hemorrhage: report from a multihospital health-care system

Cited by 43 publications

References 21 publications

Impact of Physician Awareness on Diagnosis of Fetomaternal Hemorrhage

Impact of Physician Awareness on Diagnosis of Fetomaternal Hemorrhage

Fetomaternal hemorrhage complicated pregnancy

Demographic and Behavioral Predictors of Severe Fetomaternal Hemorrhage: A Case-Control Study

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