1
|
Ding XP, Hu XW, Chen S, Guo L, Wang ZL, He Y, Li LQ, Tang WY. Risk factors for necrotizing enterocolitis in small-for-gestational-age infants: a matched case-control study. Sci Rep 2024; 14:19098. [PMID: 39154081 PMCID: PMC11330453 DOI: 10.1038/s41598-024-70351-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 08/14/2024] [Indexed: 08/19/2024] Open
Abstract
Few studies have focused on the risk factors for necrotizing enterocolitis (NEC) in small for gestational age (SGA) infants. The aim of this study was to identify the risk factors for NEC in SGA newborns. This study included consecutive SGA neonates admitted to a tertiary hospital in Jiangxi Province, China from Jan 2008 to Dec 2022. Patients with NEC (Bell's stage ≥ II) were assigned to the NEC group. Gestational age- and birth weight-matched non-NEC infants born during the same period at the same hospital were assigned to the control group. The risk factors associated with NEC were analyzed with univariate and logistic regression models. During the study period, 2,912 SGA infants were enrolled, 150 (5.15%) of whom developed NEC. In total, 143 patients and 143 controls were included in the NEC and control groups, respectively. Logistic regression analysis revealed that sepsis (OR 2.399, 95% CI 1.271-4.527, P = 0.007) and anemia (OR 2.214, 95% CI 1.166-4.204, P = 0.015) might increase the incidence of NEC in SGA infants and that prophylactic administration of probiotics (OR 0.492, 95% CI 0.303-0.799, P = 0.004) was a protective factor against NEC. Therefore, sepsis, anemia and a lack of probiotic use are independent risk factors for NEC in SGA infants.
Collapse
Affiliation(s)
- Xiang-Ping Ding
- Department of Neonatology, Jiangxi Hospital Affiliated to Children's Hospital of Chongqing Medical University, Nanchang, 330103, People's Republic of China
| | - Xiang-Wen Hu
- Department of Neonatology, Jiangxi Hospital Affiliated to Children's Hospital of Chongqing Medical University, Nanchang, 330103, People's Republic of China
| | - Shi Chen
- Key Laboratory of Pediatrics in Chongqing, Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Neonatal Diagnosis and Treatment Center, Children's Hospital of Chongqing Medical University, Chongqing, 400014, People's Republic of China
| | - Lu Guo
- Key Laboratory of Pediatrics in Chongqing, Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Neonatal Diagnosis and Treatment Center, Children's Hospital of Chongqing Medical University, Chongqing, 400014, People's Republic of China
| | - Zheng-Li Wang
- Department of Neonatology, Jiangxi Hospital Affiliated to Children's Hospital of Chongqing Medical University, Nanchang, 330103, People's Republic of China
- Key Laboratory of Pediatrics in Chongqing, Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Neonatal Diagnosis and Treatment Center, Children's Hospital of Chongqing Medical University, Chongqing, 400014, People's Republic of China
| | - Yu He
- Key Laboratory of Pediatrics in Chongqing, Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Neonatal Diagnosis and Treatment Center, Children's Hospital of Chongqing Medical University, Chongqing, 400014, People's Republic of China
| | - Lu-Quan Li
- Department of Neonatology, Jiangxi Hospital Affiliated to Children's Hospital of Chongqing Medical University, Nanchang, 330103, People's Republic of China
- Key Laboratory of Pediatrics in Chongqing, Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Neonatal Diagnosis and Treatment Center, Children's Hospital of Chongqing Medical University, Chongqing, 400014, People's Republic of China
| | - Wen-Yan Tang
- Department of Neonatology, Jiangxi Hospital Affiliated to Children's Hospital of Chongqing Medical University, Nanchang, 330103, People's Republic of China.
- Jiangxi Maternal and Child Health Hospital, Maternal and Child Health Hospital of Nanchang Medical College, Nan Chan, 330038, Jiangxi, China.
| |
Collapse
|
2
|
Chan Poon KTC, Li L, Pittman R, Hornik CD, Tanaka DT, Katakam L, Goldberg RN, Cotten CM, Athavale KV. Decreasing Blood Transfusions in Premature Infants Through Quality Improvement. Pediatrics 2024; 154:e2023063728. [PMID: 39015101 DOI: 10.1542/peds.2023-063728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 04/26/2024] [Accepted: 05/02/2024] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Packed red blood cell transfusions (pRBCT) in preterm infants have been associated with significant morbidity. Although infants <26 weeks' gestational age typically require several pRBCT, preterm infants born between 26 and 34 weeks' gestational age may also require pRBCT during their hospitalization that are potentially preventable. We aimed to reduce pRBCT in this population by 20%. METHODS This quality improvement project was conducted in the Duke University Hospital NICU between July 2018 and February 2023. Interventions included the implementation of evidence-based transfusion thresholds, supporting bone marrow erythropoiesis, and reducing laboratory specimen volumes by increasing capillary test panels. The rates per 1000 patient days for pRBCT (outcome measure), number of new patients initiated on erythropoietin (process measure), number of basic metabolic panels (process measure), and total capillary panels (process measure) were monitored during the project period. Statistical process control charts were used to observe trends over time. RESULTS Among infants born between 26 0/7 and 34 6/7 weeks' gestational age, the rate of pRBCT decreased from an average of 23.8 to 12.7 transfusions per 1000 patient days, which is a 46.6% decrease. Increases in the use of erythropoietin and capillary panels were observed, along with a decrease in the use of basic metabolic panels. There was no change in mortality or the rate of necrotizing enterocolitis. Improvement was sustained for 24 months after implementation. CONCLUSIONS pRBCT can be decreased in preterm infants born between 26 and 34 completed weeks' gestation through a combination of strategies utilizing quality improvement methodology.
Collapse
Affiliation(s)
- Kwai Tei C Chan Poon
- Department of Pediatrics, Division of Neonatology, Duke University Hospital, Durham, North Carolina
| | - Lusia Li
- Department of Pediatrics, Division of Neonatology, Duke University Hospital, Durham, North Carolina
| | - Rick Pittman
- Department of Pediatrics, Division of Neonatology, Duke University Hospital, Durham, North Carolina
| | - Chi Dang Hornik
- Duke Clinical Research Institute, Durham, North Carolina
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - David T Tanaka
- Department of Pediatrics, Division of Neonatology, Duke University Hospital, Durham, North Carolina
| | - Lakshmi Katakam
- Department of Pediatrics, Division of Neonatology, Duke University Hospital, Durham, North Carolina
| | - Ronald N Goldberg
- Department of Pediatrics, Division of Neonatology, Duke University Hospital, Durham, North Carolina
| | - C Michael Cotten
- Department of Pediatrics, Division of Neonatology, Duke University Hospital, Durham, North Carolina
| | - Kamlesh V Athavale
- Department of Pediatrics, Division of Neonatology, Duke University Hospital, Durham, North Carolina
| |
Collapse
|
3
|
Calandrino A, Montobbio C, Bonato I, Cipresso G, Vinci F, Caruggi S, Battaglini M, Andreato C, Mongelli F, Massirio P, Brigati G, Minghetti D, Ramenghi LA. Optimizing haemoglobin measurements in VLBW newborns: Insights from a comparative retrospective study. Early Hum Dev 2024; 190:105949. [PMID: 38290276 DOI: 10.1016/j.earlhumdev.2024.105949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/21/2024] [Accepted: 01/22/2024] [Indexed: 02/01/2024]
Abstract
INTRODUCTION Haemoglobin levels assessment is a crucial part of neonatal intensive care practice, the painful experience of repeated heel pricks and venepunctures blood sampling may negatively affect neonatal clinical course. To date the reliability of haemoglobin levels obtained by point-of-care testing (POCT) analysis if compared to standard blood cell count remains controversial. MATERIALS AND METHODS Retrospective study conducted on all inborn premature infants (gestational age < 32 weeks) admitted to NICU of the IRCCS Giannina Gaslini Institute during the period May 2021-April 2023. We considered blood samplings occurred within the first 28 days of life recording the laboratory haemoglobin levels (Hblab) (reference method), the point-of-care haemoglobin levels (HbPOCT) (alternative method) and the type of puncture (arterial, venous and capillary). A Bland-Altman analysis was performed to evaluate the Hb agreement, it determines the bias (mean difference between the reference and alternative methods) and limits of agreement (LOA; lower, l-LOA; upper, u-LOA) of measures. An acceptable limit of agreement was 1 g/dl according to the existing literature. RESULTS We considered 845 blood samplings from 189 enrolled patients. The comparison between the reference and the alternative method showed a good agreement for the capillary sampling technique with l-LOA of -0.717 (-0.776; -0.659) and u-LOA of 0.549 (0.490; 0.607), these results were not achievable with the other techniques, with LOAs over ±1 g/dl threshold (venous CONCLUSIONS The reliability of capillary POCT measured haemoglobin levels may reduce clinical-related costs and the number of painful experiences, with obvious positive effects on the daily neonatal life in the NICU and on the developing brain structures.
Collapse
Affiliation(s)
- Andrea Calandrino
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, Italy; Neonatal Intensive Care Unit, IRCCS Giannina Gaslini Institute, 16147 Genoa, Italy
| | - Carolina Montobbio
- Neonatal Intensive Care Unit, IRCCS Giannina Gaslini Institute, 16147 Genoa, Italy.
| | - Irene Bonato
- Neonatal Intensive Care Unit, IRCCS Giannina Gaslini Institute, 16147 Genoa, Italy
| | - Gaia Cipresso
- Neonatal Intensive Care Unit, IRCCS Giannina Gaslini Institute, 16147 Genoa, Italy
| | - Francesco Vinci
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, Italy; Neonatal Intensive Care Unit, IRCCS Giannina Gaslini Institute, 16147 Genoa, Italy
| | - Samuele Caruggi
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, Italy; Neonatal Intensive Care Unit, IRCCS Giannina Gaslini Institute, 16147 Genoa, Italy
| | - Marcella Battaglini
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, Italy; Neonatal Intensive Care Unit, IRCCS Giannina Gaslini Institute, 16147 Genoa, Italy
| | - Chiara Andreato
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, Italy; Neonatal Intensive Care Unit, IRCCS Giannina Gaslini Institute, 16147 Genoa, Italy
| | - Federica Mongelli
- Neonatal Intensive Care Unit, IRCCS Giannina Gaslini Institute, 16147 Genoa, Italy
| | - Paolo Massirio
- Neonatal Intensive Care Unit, IRCCS Giannina Gaslini Institute, 16147 Genoa, Italy
| | - Giorgia Brigati
- Neonatal Intensive Care Unit, IRCCS Giannina Gaslini Institute, 16147 Genoa, Italy
| | - Diego Minghetti
- Neonatal Intensive Care Unit, IRCCS Giannina Gaslini Institute, 16147 Genoa, Italy
| | - Luca Antonio Ramenghi
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, Italy; Neonatal Intensive Care Unit, IRCCS Giannina Gaslini Institute, 16147 Genoa, Italy
| |
Collapse
|
4
|
Daousani C, Karalis V, Loukas YL, Schulpis KH, Alexiou K, Dotsikas Y. Dried Blood Spots in Neonatal Studies: A Computational Analysis for the Role of the Hematocrit Effect. Pharmaceuticals (Basel) 2023; 16:1126. [PMID: 37631041 PMCID: PMC10459320 DOI: 10.3390/ph16081126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/29/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
Dried blood spot (DBS) microsampling is extensively employed in newborn screening (NBS) and neonatal studies. However, the impact of variable neonatal hematocrit (Ht) values on the results can be a source of analytical error, and the use of fixed Ht for calibration (Htcal) is not representative of all neonatal subpopulations. A computational approach based on neonatal demographics was developed and implemented in R® language to propose a strategy using correction factors to address the Ht effect in neonatal DBS partial-spot assays. A rational "tolerance level" was proposed for the Ht effect contribution to the total analytical error and a safe Ht range for neonatal samples, where the correction of concentrations can be omitted. Furthermore, an "alert zone" for a false positive or negative result in NBS was proposed, where the Ht effect has to be considered. Results point toward the use of Htcal values closely representative of populations under analysis and an acceptable level of percentage relative error can be attributed to the Ht effect, diminishing the probability of correction. Overall, the impact of the Ht effect on neonatal studies is important and future work may further investigate this parameter, correlated to other clinical variables potentially affecting results.
Collapse
Affiliation(s)
- Chrysa Daousani
- Laboratory of Pharmaceutical Analysis, Department of Pharmacy, National and Kapodistrian University of Athens, Panepistimiopolis, 157 84 Athens, Greece
| | - Vangelis Karalis
- Laboratory of Biopharmaceutics-Pharmacokinetics, Department of Pharmacy, National and Kapodistrian University of Athens, Panepistimiopolis, 157 84 Athens, Greece
| | - Yannis L. Loukas
- Laboratory of Pharmaceutical Analysis, Department of Pharmacy, National and Kapodistrian University of Athens, Panepistimiopolis, 157 84 Athens, Greece
| | | | | | - Yannis Dotsikas
- Laboratory of Pharmaceutical Analysis, Department of Pharmacy, National and Kapodistrian University of Athens, Panepistimiopolis, 157 84 Athens, Greece
| |
Collapse
|
5
|
Xie L, Ding L, Tang L, Yang Z, Wu D, Wang W, Mao J, Shi L, Liu C, Duan L, Xu J, Zhou Q, Sun J, Ding X. A real-world cost-effectiveness study of vancomycin versus linezolid for the treatment of late-onset neonatal sepsis in the NICU in China. BMC Health Serv Res 2023; 23:771. [PMID: 37468855 PMCID: PMC10357666 DOI: 10.1186/s12913-023-09628-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 05/31/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Currently, the detection rates of methicillin-resistant S. aureus (MRSA) and methicillin-resistant coagulase-negative staphylococci (MRCoNS) in the blood cultures of neonates with sepsis exceed the national average drug resistance level, and vancomycin and linezolid are the primary antibacterial drugs used for these resistant bacteria according to the results of etiological examinations. However, a comprehensive evaluation of their costs and benefits in late-onset neonatal sepsis in a neonatal intensive care unit (NICU) has not been conducted. This study aimed to compare the cost and effectiveness of vancomycin and linezolid in treating neonatal sepsis in the NICU. METHODS A cost-effectiveness analysis of real-world data was carried out by retrospective study in our hospital, and the cost and effectiveness of vancomycin and linezolid were compared by establishing a decision tree model. The drug doses in the model were 0.6 g for linezolid and 0.5 g for vancomycin. The cost break down included cost of medical ward, NICU stay, intravenous infusion of vancomycin or linezolid, all monitoring tests, culture tests and drugs. The unit costs were sourced from hospital information systems. The effectiveness rates were obtained by cumulative probability analysis. One-way sensitivity analysis was used to analyze uncertain influencing factors. RESULTS The effectiveness rates of vancomycin and linezolid in treating neonatal sepsis in the NICU were 89.74% and 90.14%, respectively, with no significant difference. The average cost in the vancomycin group was ¥12261.43, and the average cost in the linezolid group was ¥17227.96. The incremental cost effectiveness was ¥12416.33 cost per additional neonate with treatment success in the linezolid group compared to vancomycin group at discharge. Factors that had the greatest influence on the sensitivity of the incremental cost-effectiveness ratio were the price of linezolid and the effectiveness rates. CONCLUSIONS The cost for treatment success of one neonate in linezolid group was ¥5449.17 more than that in vancomycin group, indicating that vancomycin was more cost-effective. Therefore, these results can provide a reference for a cost effectiveness treatment scheme for neonatal sepsis in the NICU.
Collapse
Affiliation(s)
- Linjun Xie
- Department of Pharmacy, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Leyun Ding
- Department of Pharmacy, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Lian Tang
- Department of Pharmacy, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Zuming Yang
- Department of Neonatology, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Dan Wu
- Department of Pharmacy, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Wenjuan Wang
- Children's Hospital of Soochow University, Medical College of Soochow University, Soochow University, Suzhou, China
| | - Juehui Mao
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Lu Shi
- Department of Pharmacy, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Chun Liu
- Department of Pharmacy, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Lufen Duan
- Department of Pharmacy, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Jinhui Xu
- Department of Pharmacy, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Qin Zhou
- Department of Pharmacy, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China.
| | - Jiantong Sun
- Department of Pharmacy, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China.
| | - Xinyuan Ding
- Department of Pharmacy, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China.
| |
Collapse
|
6
|
Tweddell SM, Bahr TM, Henry E, Page JM, Ilstrup SJ, Ohls RK, Christensen RD. Placental abruption and neonatal anemia. J Perinatol 2023; 43:782-786. [PMID: 36650233 DOI: 10.1038/s41372-023-01603-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/04/2023] [Accepted: 01/06/2023] [Indexed: 01/19/2023]
Abstract
OBJECTIVE 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. RESULTS Of 55,111 births, 678 (1.2%) had confirmed abruption; 83% of these neonates (564) had one or more hemoglobins recorded in the first day. Four-hundred-seventy (83.3%) had a normal hemoglobin (≥5th% reference interval) while 94 (16.7%) 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 identified the abruption as "small" or "marginal" the risk of anemia was insignificant. CONCLUSIONS Most 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.
Collapse
Affiliation(s)
- Sarah M Tweddell
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA.
| | - Timothy M Bahr
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
- Obstetric and Neonatal Operations, Intermountain Healthcare, Salt Lake City, UT, USA
| | - Erick Henry
- Obstetric and Neonatal Operations, Intermountain Healthcare, Salt Lake City, UT, USA
| | - Jessica M Page
- Obstetric and Neonatal Operations, Intermountain Healthcare, Salt Lake City, UT, USA
| | - Sarah J Ilstrup
- Transfusion Medicine, Intermountain Medical Center, Murray, UT, USA
| | - Robin K Ohls
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Robert D Christensen
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
- Obstetric and Neonatal Operations, Intermountain Healthcare, Salt Lake City, UT, USA
| |
Collapse
|
7
|
Joshi R, Myers E, Kokhanov A. Congenital Disorders of Red Blood Cells. Neoreviews 2022; 23:e813-e828. [PMID: 36450647 DOI: 10.1542/neo.23-12-e813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
See Bonus NeoBriefs videos and downloadable teaching slides Understanding the physiologic process of red blood cell development in utero and subsequent erythropoiesis in the neonate is crucial as this determines red blood cell structure and therefore function, which is vital to neonatal health. Infants frequently experience anemia, and special consideration must be given to the evaluation of these infants to determine the correct etiology. Traditionally, anemia is conceptualized in terms of inadequate red blood cell production, increased red blood cell destruction, or whole blood loss. This framework translates well to inherited red blood cell defects, which include genetic abnormalities in bone marrow productivity or structure of the red blood cell membrane, enzymes, or hemoglobin. This article highlights fetal and neonatal erythropoiesis and the underlying etiologies of the inherited red blood cell disorders, as well as reviews the appropriate diagnostic evaluation and next steps in management. It is imperative that neonatal clinicians remain informed about these disorders to enable early recognition and treatment, and ultimately to improve outcomes in affected infants.
Collapse
Affiliation(s)
- Rhucha Joshi
- Division of Neonatal Medicine, Department of Pediatrics, University of California Irvine, Irvine, CA
| | - Erin Myers
- Department of Pediatrics, University of California Irvine, Irvine, CA
| | - Artemiy Kokhanov
- Department of Neonatology, MemorialCare Miller Children's and Women's Hospital Long Beach, Long Beach, CA
| |
Collapse
|
8
|
Relationship of Early Anemia with Neurodevelopment and Brain Injury in Very Low Birth Weight Preterm Infants-A Prospective Cohort Study. Nutrients 2022; 14:nu14224931. [PMID: 36432616 PMCID: PMC9695480 DOI: 10.3390/nu14224931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/08/2022] [Accepted: 11/17/2022] [Indexed: 11/23/2022] Open
Abstract
Anemia is associated with neurodevelopmental delays and brain injury in infants and toddlers, but whether early anemia has a similar effect in neonatal preterm infants is largely unknown. Thus, this study aimed to determine the relationship of early anemia with neurodevelopment and brain injury in very-low-birth-weight (VLBW) preterm infants within the neonatal period. A prospective cohort study including 110 VLBW preterm infants was conducted in Southern China from 2016 to 2018. All participants were followed from birth to 1 month corrected age. Early anemia is defined as hemoglobin of ≤145 g/L within the first week after birth. The non-anemic group (control group, N = 55) was 1:1 matched with the early anemia group (N = 55) according to birth weight and gestational age. Neurodevelopment at 1 month corrected age and brain injury within 1 month corrected age were measured by neonatal behavioral neurological assessments (NBNA) and cranial ultrasound, respectively. Compared to the control group, the early anemia group had a lower score in behavioral ability in the NBNA test [11 (10-12) vs. 10 (9.5-11), p = 0.033]. Early anemia was negatively associated with the NBNA total score (β= -0.680, 95% CI: -1.300, -0.059), especially with the behavioral ability score (β= -0.504, 95% CI: -0.941, -0.067) after adjusting for the confounders. However, no association between early anemia and brain injury was observed. In conclusion, in VLBW preterm infants, early anemia is negatively correlated with neurodevelopment, especially with behavioral ability.
Collapse
|
9
|
Taylor S, Terkildsen M, McQuilty R, Lee D, Wing-Simpson A, Gray R. Non-essential heavy metals and protective effects of selenium against mercury toxicity in endangered Australian sea lion (Neophoca cinerea) pups with hookworm disease. ENVIRONMENT INTERNATIONAL 2022; 169:107521. [PMID: 36148712 DOI: 10.1016/j.envint.2022.107521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 08/06/2022] [Accepted: 09/11/2022] [Indexed: 06/16/2023]
Abstract
The endangered Australian sea lion, Neophoca cinerea, faces ongoing population decline. Identification of key threats to N. cinerea population recovery, including disease and pollutants, is an objective of the species' recovery plan. Previous studies have identified Uncinaria sanguinis, an intestinal nematode, as a significant cause of disease and mortality in N. cinerea pups. Given the impact of heavy metals on the immune response, investigation of these pollutants is critical. To this end, the concentrations of arsenic (As), total mercury (Hg), cadmium (Cd), chromium (Cr), lead (Pb) and selenium (Se) were determined in blood collected from N. cinerea pups sampled during the 2017/18, 2019 and 2020/21 breeding seasons at Seal Bay Conservation Park, South Australia. Significant differences (p < 0.05) in Hg, As, Cr, and Se concentrations and molar ratio of Se:Hg were seen between breeding seasons. Pup age, maternal parity and inter-individual foraging behaviour were considered factors driving these differences. The concentrations of Hg (357, 198 and 241 µg/L) and As (225, 834 and 608 µg/L) were high in 2017/18, 2019 and 2020/21 respectively with Hg concentrations in the blood of N. cinerea pups above toxicological thresholds reported for marine mammals. The concentration of Se (1332, 647, 763 µg/L) and molar ratio of Se:Hg (9.47, 7.98 and 6.82) were low compared to other pinniped pups, indicating potential vulnerability of pups to the toxic effects of Hg. Significant (p < 0.05) negative associations for Pb and Cd with several red blood cell parameters suggest they could be exacerbating the anaemia caused by hookworm disease. Temporal (age-related) changes in element concentrations were also seen, such that pup age needs to be considered when interpreting bioaccumulation patterns. Further investigation of the role of elevated heavy metal concentrations on N. cinerea pup health, disease and development is recommended, particularly with respect to immunological impacts.
Collapse
Affiliation(s)
- Shannon Taylor
- Sydney School of Veterinary Science, Faculty of Science, The University of Sydney, Camperdown, NSW 2006, Australia
| | | | - Robert McQuilty
- Department of Chemical Pathology, Royal Prince Alfred Hospital, Camperdown, Sydney 2050, Australia
| | - David Lee
- Department of Chemical Pathology, Royal Prince Alfred Hospital, Camperdown, Sydney 2050, Australia
| | - Aileen Wing-Simpson
- Department of Chemical Pathology, Royal Prince Alfred Hospital, Camperdown, Sydney 2050, Australia
| | - Rachael Gray
- Sydney School of Veterinary Science, Faculty of Science, The University of Sydney, Camperdown, NSW 2006, Australia.
| |
Collapse
|
10
|
Bruinsma MAW, de Boer MA, Prins S, Abheiden CNH. Does placental abruption cause neonatal anemia? Acta Obstet Gynecol Scand 2022; 101:917-922. [PMID: 35582929 DOI: 10.1111/aogs.14376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 03/27/2022] [Accepted: 04/14/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Placental abruption can result in serious perinatal morbidity and mortality. However, it is not clear whether placental abruption could lead to neonatal anemia, as a direct relationship has not been described yet. The objective of this study is to investigate whether there is a relationship between occurrence of placental abruption and neonatal anemia. MATERIAL AND METHODS All women with a clinical diagnoses of placental abruption between January 2016 and April 2021 in Amsterdam UMC, from both the VU University Medical Center and Amsterdam Medical Center, were included. Demographic data and delivery outcomes were collected retrospectively using the medical files. The primary outcome was neonatal anemia, defined as hemoglobin levels less than the fifth percentile for gestational age. RESULTS A total of 65 mothers and 65 neonates were included in our study. Average gestational age was 30 + 5 weeks. Mean hemoglobin level of the neonates at birth was 16.5 g/dl (10.2 mmol/L) with hemoglobin levels comparable to the reference curve. Two neonates (3.6%) were diagnosed with anemia based on their hemoglobin level at birth, and six (9.2%) neonates received a blood transfusion within 24 h after birth. CONCLUSIONS With this study, we found that the hemoglobin levels of the neonates born after placental abruption are comparable to the reference curve and do not show more neonates than expected below the fifth percentile for gestational age. It remains unclear whether there is fetal blood loss during a placental abruption but our results suggest that at least a big amount of fetal blood is not lost, since we did not found a large number of anemic neonates. Severe neonatal anemia in the case of placental abruption does not need to be expected.
Collapse
Affiliation(s)
- Marieke A W Bruinsma
- Obstetrics and Gynecology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Pregnancy and Birth, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Marjon A de Boer
- Obstetrics and Gynecology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Pregnancy and Birth, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Sandra Prins
- Neonatology Amsterdam, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Child Development, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Carolien N H Abheiden
- Obstetrics and Gynecology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Pregnancy and Birth, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| |
Collapse
|
11
|
Saito-Benz M, Bennington K, Gray CL, Murphy WG, Flanagan P, Steiner F, Atkinson G, Berry MJ. Effects of Freshly Irradiated vs Irradiated and Stored Red Blood Cell Transfusion on Cerebral Oxygenation in Preterm Infants: A Randomized Clinical Trial. JAMA Pediatr 2022; 176:e220152. [PMID: 35344031 PMCID: PMC8961404 DOI: 10.1001/jamapediatrics.2022.0152] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Gamma irradiation of leukoreduced red blood cells (RBCs) prevents transfusion-associated graft-vs-host disease but also exacerbates storage lesion formation in RBCs. It is unknown whether freshly irradiated RBCs are more efficacious than irradiated and stored RBCs in preterm infants with high transfusion requirements. OBJECTIVE To examine whether transfusion of freshly irradiated vs irradiated and stored RBC components improves cerebral oxygen delivery in preterm infants with anemia. DESIGN, SETTING, AND PARTICIPANTS This single-center, double-blinded, proof-of-concept randomized clinical trial was conducted at the neonatal intensive care unit of Wellington Regional Hospital in Wellington, New Zealand, between December 1, 2017, and November 30, 2018. Participants were preterm infants (<34 weeks' gestation at birth) who were at least 14 days of age and had anemia. Participants underwent nonurgent transfusions, and these episodes were randomized to the intervention group (in which the infants received a transfusion of RBCs that were freshly irradiated on the day of transfusion) or control group (in which the infants received a transfusion of RBCs that were irradiated and stored for up to 14 days). Data were analyzed using the evaluable population approach. INTERVENTION Transfusion of freshly irradiated RBCs. MAIN OUTCOMES AND MEASURES The prespecified primary outcome was the change in cerebral regional oxygen saturation (crSO2) from baseline (immediately before) to immediately after the transfusion. The prespecified secondary outcomes were the change in cerebral fractional tissue oxygen extraction (cFTOE) at different time points (immediately after, 24 hours after, and 120 hours or 5 days after transfusion). Outcomes were measured by blinded clinicians using near-infrared spectroscopy. A covariate-adjusted linear mixed model was used to quantify mean treatment effects and account for multiple transfusions in some infants. RESULTS A total of 42 infants (mean [SD] gestational age, 26 [10] weeks and 3 days; 29 [69%] boys) were enrolled in the trial and underwent 64 transfusion episodes, which were randomized to the intervention (n = 31) or control (n = 33) group. Compared with infants in the control group, those in the intervention group showed a covariate-adjusted mean increase in crSO2 (2.0 percentage points; 95% CI, 1.2-2.8 percentage points) and a mean decrease in cFTOE (0.02; 95% CI, 0.01-0.04) immediately after transfusion. These differences were sustained up to 120 hours or 5 days after transfusion. There were negligible mean changes in crSO2 or cFTOE in infants in the control group at any of the follow-up time points. CONCLUSIONS AND RELEVANCE Results of this trial showed that transfusion of freshly irradiated RBCs conferred a small advantage in cerebral oxygenation for at least 5 days after transfusion compared with transfusion of irradiated and stored RBC components. On-demand irradiation of RBC components may be considered to optimize oxygen delivery in the recipient, but this physiological finding requires further research. TRIAL REGISTRATION ANZCTR Identifier: ACTRN12617001581358.
Collapse
Affiliation(s)
- Maria Saito-Benz
- Department of Pediatrics and Child Health, University of Otago, Wellington, New Zealand,Neonatal Intensive Care Unit, Wellington Regional Hospital, Wellington, New Zealand
| | - Karen Bennington
- Neonatal Intensive Care Unit, Wellington Regional Hospital, Wellington, New Zealand
| | - Clint L. Gray
- Department of Pediatrics and Child Health, University of Otago, Wellington, New Zealand,Centre for Translational Physiology, University of Otago, Wellington, New Zealand
| | - William G. Murphy
- New Zealand Blood Service, Wellington Regional Hospital, Wellington, New Zealand,School of Medical Science, University College, Dublin, Ireland
| | - Peter Flanagan
- New Zealand Blood Service, Wellington Regional Hospital, Wellington, New Zealand
| | - Frederica Steiner
- Neonatal Intensive Care Unit, Wellington Regional Hospital, Wellington, New Zealand
| | - Greg Atkinson
- Faculty of Science, Liverpool John Moores University, Liverpool, United Kingdom
| | - Mary J. Berry
- Department of Pediatrics and Child Health, University of Otago, Wellington, New Zealand,Neonatal Intensive Care Unit, Wellington Regional Hospital, Wellington, New Zealand,Centre for Translational Physiology, University of Otago, Wellington, New Zealand
| |
Collapse
|
12
|
Michael SA, Hayman DTS, Gray R, Roe WD. Clinical parameters of hypervirulent Klebsiella pneumoniae disease and ivermectin treatment in New Zealand sea lion (Phocarctos hookeri) pups. PLoS One 2022; 17:e0264582. [PMID: 35239682 PMCID: PMC8893627 DOI: 10.1371/journal.pone.0264582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 02/11/2022] [Indexed: 11/30/2022] Open
Abstract
Hypervirulent Klebsiella pneumoniae infection causes significant mortality of endangered New Zealand sea lion pups at Enderby Island, Auckland Islands. Gross necropsy and histopathology findings are well reported, but little is known about the clinical course of disease in affected pups. To determine factors feasible as clinical screening tools for hypervirulent K. pneumoniae in live pups, 150 pups over two field seasons (2016–18) were recruited shortly after birth for a prospective cohort study. A randomised controlled clinical treatment trial with the anthelmintic ivermectin was conducted concurrently and risk factor data and biological samples were collected approximately fortnightly. Treatment with ivermectin has been demonstrated to reduce the risk of hypervirulent K. pneumoniae mortality in pups, so effects on clinical parameters between the treated and control cohorts were also investigated. A broader sample of pups were monitored for clinical signs to investigate the course of disease in affected pups. Clinical signs, haematology and oral and rectal swabs to detect gastrointestinal carriage of hypervirulent K. pneumoniae were not useful for detection of disease prior to death. Of those pups that died due to hypervirulent K. pneumoniae, only 26.1% (18/69) had any clinical signs prior, likely a reflection of the peracute course of disease. On comparison of haematological parameters between ivermectin-treated and control pups, significantly lower total plasma protein and higher eosinophil counts were seen in control versus treated pups, however standard length as a surrogate for age was a more important influence on parameters overall than ivermectin treatment. This study also highlighted a cohort of pups with severe clinical signs suggestive of hypervirulent K. pneumoniae infection were lost to follow up at the end of the monitored season, which could be contributing to cryptic juvenile mortality.
Collapse
Affiliation(s)
- Sarah A. Michael
- Sydney School of Veterinary Science, The University of Sydney, Camperdown NSW, Australia
- School of Veterinary Science, Massey University, Palmerston North, New Zealand
- * E-mail:
| | - David T. S. Hayman
- Molecular Epidemiology and Public Health Laboratory, Hopkirk Research Institute, Massey University, Palmerston North, New Zealand
| | - Rachael Gray
- Sydney School of Veterinary Science, The University of Sydney, Camperdown NSW, Australia
| | - Wendi D. Roe
- School of Veterinary Science, Massey University, Palmerston North, New Zealand
| |
Collapse
|
13
|
Walker S, Coray E, Ginsberg-Peltz J, Smith L. A Five-Week-Old Twin With Profound Anemia: A Case Report of Asymmetric Congenital Babesiosis. Cureus 2022; 14:e22774. [PMID: 35382190 PMCID: PMC8974790 DOI: 10.7759/cureus.22774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2022] [Indexed: 01/10/2023] Open
Abstract
We present a case report and review of the literature of congenital transmission of babesiosis in a five-week-old twin neonate evaluated for lethargy and difficulty with feeding. On presentation to the pediatric emergency department, the patient appeared pale and was found to be profoundly anemic with intraerythrocytic ringed parasites consistent with Babesia microti visible on a thin smear. The patient received a blood transfusion and was treated with a regimen of atovaquone and azithromycin with full recovery. The other twin remained asymptomatic with negative Babesia polymerase chain reaction testing.
Collapse
Affiliation(s)
- Sulynn Walker
- Emergency Medicine, Baystate Medical Center, Springfield, USA
| | - Elizabeth Coray
- Pediatric Emergency Medicine, Baystate Medical Center, Springfield, USA
| | | | - Liza Smith
- Emergency Medicine, Baystate Medical Center, Springfield, USA
| |
Collapse
|
14
|
Smith A, Armstrong S, Dempsey E, El-Khuffash A. The impact of a PDA on tissue oxygenation and haemodynamics following a blood transfusion in preterm infants. Pediatr Res 2022; 93:1314-1320. [PMID: 35152266 DOI: 10.1038/s41390-022-01967-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 01/04/2022] [Accepted: 01/17/2022] [Indexed: 01/08/2023]
Abstract
BACKGROUND To examine the impact of PRBC transfusion on pulmonary vascular resistance (PVR), systemic vascular resistance and myocardial function using echocardiography and cerebral and splanchnic tissue oxygenation using near-infrared spectroscopy (NIRS) in premature babies with and without a PDA. METHODS A prospective observational study of premature infants born <1500 g in receipt of PRBC transfusions beyond 10 days of age. Echocardiography and NIRS monitoring were performed at baseline, during the transfusion and 24 h after transfusion. RESULTS Thirty infants with a median gestation of 26.4 [24.8-28.0] weeks were enrolled. Ten infants had a PDA. Following transfusion, a significant decrease in PVR markers occurred in all infants. Right ventricular (RV) function increased following transfusion in the PDA closed group only. Cerebral oxygen saturation increased following transfusion in all infants. Babies in the PDA open group had significantly lower splanchnic oxygen saturations at baseline compared to the PDA closed group which persisted over the study period and were unaltered by transfusion. CONCLUSIONS PRBC transfusion lowers PVR irrespective of PDA status. Those with a PDA demonstrated a lack of improvement in RV function and splanchnic oxygenation highlighting the impact a PDA has on the neonatal circulation. IMPACT The presence or absence of the PDA imposes differential effects on splanchnic oxygenation during red blood cell (PRBC) transfusion in the premature population. This is the first study to assess the impact of the PDA on splanchnic oxygenation via near-infrared spectroscopy (NIRS) during red blood cell transfusion in premature neonates. New insights have been found into the impact of PRBC transfusion on pulmonary vascular resistance, right ventricular function, cerebral and splanchnic oxygenation in the presence and absence of a PDA and emphasises the ongoing impact of ductal patency on gut oxygenation.
Collapse
Affiliation(s)
- Aisling Smith
- Department of Neonatology, The Rotunda Hospital, Dublin, Ireland.
| | - Sean Armstrong
- Department of Neonatology, The Rotunda Hospital, Dublin, Ireland
| | - Eugene Dempsey
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland.,INFANT Centre, University College Cork, Cork, Ireland
| | - Afif El-Khuffash
- Department of Neonatology, The Rotunda Hospital, Dublin, Ireland.,Department of Paediatrics, The Royal College of Surgeons in Ireland, Dublin, Ireland
| |
Collapse
|
15
|
Kalteren WS, Bos AF, van Oeveren W, Hulscher JBF, Kooi EMW. Neonatal anemia relates to intestinal injury in preterm infants. Pediatr Res 2022; 91:1452-1458. [PMID: 34907357 PMCID: PMC8670618 DOI: 10.1038/s41390-021-01903-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 10/03/2021] [Accepted: 11/26/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Anemia is associated with decreased tissue oxygenation in preterm infants and may contribute to developing necrotizing enterocolitis (NEC). We aimed to investigate whether hemoglobin level is associated with intestinal injury, by comparing anemic infants 10 days prior to red blood cell (RBC) transfusion with non-anemic controls. METHODS A nested case-control study in which we matched anemic preterms (gestational age (GA) < 32 weeks) with non-anemic controls (1:1), based on GA, birth weight (BW), and postnatal age. We measured urinary intestinal fatty acid-binding protein, I-FABP, marker for intestinal injury, twice weekly. Simultaneously, we assessed splanchnic oxygen saturation (rsSO2) and rsSO2 variability. RESULTS Thirty-six cases and 36 controls were included (median GA 27.6 weeks, BW 1020 grams). Median I-FABP level was higher in cases from 6 days to 24-h before transfusion (median ranging: 4749-8064 pg/ml versus 2194-3751 pg/ml). RsSO2 and rsSO2 variability were lower in cases than controls shortly before transfusion. Hemoglobin levels correlated negatively with rsSO2 and rsSO2 variability in cases, and negatively with I-FABP in cases and controls together. CONCLUSIONS Urinary I-FABP levels were higher in anemic infants before RBC transfusion than in non-anemic matched controls, suggesting intestinal injury associated with anemia. This may predispose to NEC in some anemic preterm infants. IMPACT Anemia is a common comorbidity in preterm infants and may lead to impaired splanchnic oxygen saturation and intestinal tissue hypoxia, a proposed mechanism for NEC. Lower hemoglobin level is associated with higher urinary I-FABP levels, a marker for intestinal injury, both in anemic preterm infants and in cases and controls together. Lower splanchnic oxygen saturation and reduction of its variability are associated with higher urinary I-FABP levels in anemic preterm infants before their first RBC transfusion. These results support the hypothesis that anemia in very preterm infants results in intestinal cell injury, which may precede NEC development in some.
Collapse
Affiliation(s)
- Willemien S. Kalteren
- grid.4494.d0000 0000 9558 4598Division of Neonatology, Department of Pediatrics, Beatrix Children’s Hospital, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Arend F. Bos
- grid.4494.d0000 0000 9558 4598Division of Neonatology, Department of Pediatrics, Beatrix Children’s Hospital, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Jan B. F. Hulscher
- grid.4494.d0000 0000 9558 4598Division of Pediatric Surgery, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Elisabeth M. W. Kooi
- grid.4494.d0000 0000 9558 4598Division of Neonatology, Department of Pediatrics, Beatrix Children’s Hospital, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| |
Collapse
|
16
|
Ming S, Zhang D, Chen L, Shi Y. Effects of anemia and red blood cell transfusion in preterm infants on the development of bronchopulmonary dysplasia: a propensity score analysis. ALL LIFE 2021. [DOI: 10.1080/26895293.2021.1972350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Shishi Ming
- Department of Neonatology, Children’s Hospital of Chongqing Medical University; National Clinical Research Center for Child Health and Disorders; Ministry of Education Key Laboratory of Child Development and Disorders; Chongqing Key Laboratory of Pediatrics, Chongqing, People’s Republic of China
| | - Dianlong Zhang
- Department of Neonatology, Children’s Hospital of Chongqing Medical University; National Clinical Research Center for Child Health and Disorders; Ministry of Education Key Laboratory of Child Development and Disorders; Chongqing Key Laboratory of Pediatrics, Chongqing, People’s Republic of China
| | - Long Chen
- Department of Neonatology, Children’s Hospital of Chongqing Medical University; National Clinical Research Center for Child Health and Disorders; Ministry of Education Key Laboratory of Child Development and Disorders; Chongqing Key Laboratory of Pediatrics, Chongqing, People’s Republic of China
| | - Yuan Shi
- Department of Neonatology, Children’s Hospital of Chongqing Medical University; National Clinical Research Center for Child Health and Disorders; Ministry of Education Key Laboratory of Child Development and Disorders; Chongqing Key Laboratory of Pediatrics, Chongqing, People’s Republic of China
| |
Collapse
|
17
|
Hoyos AB, Vasquez-Hoyos P. Transfusion prevention using erythropoietin, parenteral sucrose iron, and fewer phlebotomies in infants born at ≤30 weeks gestation at a high altitude center: a 10-year experience. J Perinatol 2021; 41:1403-1411. [PMID: 33568772 DOI: 10.1038/s41372-021-00945-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 11/11/2020] [Accepted: 01/19/2021] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Red blood cell transfusions in infants born at ≤30 weeks gestation are frequent. Erythropoietin therapy reduces transfusions. An increase in hematocrit is an adaptive response at high altitudes but a guaranteed source of iron is necessary for adequate erythropoiesis. METHODS A retrospective cohort study was done to compare red blood cell transfusion practices of the 2019 EpicLatino (EPIC) Latin America network database with a single unit at 2650 m above sea level (LOCAL). The data from LOCAL for three time periods were compared over 10 years based on changes in erythropoietin dose and fewer phlebotomies. The number of cases that received transfusions and the total number of transfusions required were compared. Adjustments were made for known risk factors using a multivariate regression analysis. RESULTS Two hundred and twenty-one cases in LOCAL and 382 cases from EPIC were included. Overall basic demographic characteristics were similar. In EPIC a significantly higher rate of infection (28% vs. 15%) and outborn (10% vs. 1%) was found, but less necrotizing enterocolitis (9% vs. 15%) and use of prenatal steroids (62% vs. 93%) than LOCAL (p < 0.05). EPIC patients received more transfusions (2.6 ± 3 vs. 0.6 ± 1 times) than LOCAL (p < 0.001) and received them significantly more frequently (61% vs. 25%). Within the LOCAL time periods, no statistically significant differences were found other than the need for transfusions (1st 32%, 2nd 28%, 3rd 9%, p = 0.005) and the average number of transfusions (1st 0.8 ± 1.6, 2nd 0.7 ± 1.3, 3rd 0.1 ± 0.3, p = 0.004). These differences remained significant after multivariate regression analysis and adjusting for risk variables. CONCLUSION The combination of erythropoietin, parenteral sucrose iron, fewer phlebotomies during the first 72 h, and delayed umbilical cord clamping seem to reduce red blood cell transfusion needs. This can be extremely important in high altitude units where higher hematocrit is desirable but may also be valuable at sea level.
Collapse
Affiliation(s)
- Angela B Hoyos
- Division of Neonatology, Clínica del Country, Bogota, DC, Colombia. .,Universidad El Bosque, Bogota, Colombia.
| | - Pablo Vasquez-Hoyos
- Sociedad de Cirugía Hospital de San José, Bogota, Colombia.,Department of Pediatrics, Universidad Nacional de Colombia, Bogota, Colombia.,Department of Pediatrics, Fundación Universitaria de Ciencias de la Salud, Bogota, Colombia
| |
Collapse
|
18
|
Godano E, Barra F, Allodi A, Ferraiolo A, Laroni A, Novi G, Mancardi GL, Gustavino C, Arioni C. Erythropoietin therapy in a case of neonatal anemia after exposure to natalizumab throughout pregnancy. Ital J Pediatr 2021; 47:69. [PMID: 33757559 PMCID: PMC7987111 DOI: 10.1186/s13052-021-01025-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 03/15/2021] [Indexed: 11/10/2022] Open
Abstract
Background Natalizumab is a monoclonal antibody approved for the treatment of patients with relapsing-remitting multiple sclerosis. According to the current clinical recommendations, its use during pregnancy should be carefully evaluated only in women with highly active disease who plan a pregnancy or have an unplanned pregnancy, after accurate counseling about eventual maternal disease relapse due to therapy suspension. Case presentation This brief case report describes a case of documented anemia that we observed in a newborn whose mother with relapsing-remitting multiple sclerosis was treated with an extended dosing protocol of natalizumab throughout pregnancy. The newborn received the infusion of erythropoietin every seven days from the fortieth day of life; subsequently, the status of anemia underwent clinical resolution. Conclusions This case report confirmed that natalizumab can cause disorders of hematopoiesis, including anemia, thrombocytopenia, or pancytopenia, in newborns of patients treated during pregnancy. A multidisciplinary team, including experienced pediatricians and pediatric hematologists, has a critical role in managing newborns delivered by women, being treated with natalizumab for treating relapsing-remitting multiple sclerosis during pregnancy.
Collapse
Affiliation(s)
- Elisabetta Godano
- Neonatology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Fabio Barra
- Academic Unit of Obstetrics and Gynaecology, IRCCS Ospedale Policlinico San Martino, Largo R. Benzi 10, 16132, Genoa, Italy.
| | - Alessandra Allodi
- Neonatology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Antonella Ferraiolo
- Unit of Obstetrics and Gynaecology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alice Laroni
- Academic Unit of Neurology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child University of Genova, Genoa, Italy
| | - Giovanni Novi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child University of Genova, Genoa, Italy
| | - Giovanni Luigi Mancardi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child University of Genova, Genoa, Italy.,IRCCS ICS Maugeri, Pavia, Italy
| | - Claudio Gustavino
- Unit of Obstetrics and Gynaecology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Cesare Arioni
- Neonatology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| |
Collapse
|
19
|
Hussain K, Salat MS, Mohammad N, Mughal A, Idrees S, Iqbal J, Ambreen G. Meropenem-induced pancytopenia in a preterm neonate: a case report. J Med Case Rep 2021; 15:25. [PMID: 33509295 PMCID: PMC7844955 DOI: 10.1186/s13256-020-02632-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 12/14/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND A post-marketing surveillance study has reported an association between meropenem use and the incidence of hematologic abnormalities, including leukopenia, thrombocytopenia, hemolysis, and neutropenia, but the precise incidence in neonates is unknown. Here, we report meropenem-induced pancytopenia in a preterm neonate. CASE PRESENTATION A preterm newborn Pakistani received intravenous meropenem 40 mg/kg every 8 hours to treat Klebsiella pneumoniae in blood cultures and suspected meningitis. The baby developed severe thrombocytopenia, with a platelet count of 22 × 103 cells/mm3, low hemoglobin level of 9.7 g/dl, and low absolute neutrophil count (ANC) of 816 cells/mm3 on days 3, 14, and 17 of meropenem therapy, respectively. Based on the blood culture and institutional guidelines, meropenem treatment was continued with monitoring and supportive care for a total of 19 days. After discontinuation of meropenem, the baby was monitored continuously for hematological changes, and low counts persisted for 3 days. ANC improved to > 1500 cells/mm3 on the fourth day, and the platelet count reached > 150 × 103 cells/mm3 for the first time on the seventh day of meropenem discontinuation. All subsequent complete blood count (CBC) reports showed improving trends. The baby was discharged on the 48th day of life (DOL), with follow-up monitoring of CBC. The baby was kept on iron supplements, and hemoglobin level of 11.2 g/dl was observed on the 59th DOL. CONCLUSION Neonatal pancytopenia may lead to serious health complications; therefore, clinicians and pharmacists need to vigilantly monitor CBC in this vulnerable population, even when administering meropenem in septic doses for the recommended duration.
Collapse
Affiliation(s)
- Kashif Hussain
- Department of Pharmacy, Main Pharmacy Aga Khan University Hospital, Stadium Road, P.O Box 3500, Karachi, 74800 Pakistan
| | | | - Naureen Mohammad
- Department of Pharmacy, Main Pharmacy Aga Khan University Hospital, Stadium Road, P.O Box 3500, Karachi, 74800 Pakistan
| | - Ambreen Mughal
- Department of Pharmacy, Main Pharmacy Aga Khan University Hospital, Stadium Road, P.O Box 3500, Karachi, 74800 Pakistan
| | - Sidra Idrees
- Department of Paediatrics & Child Health, Aga Khan University, Karachi, Pakistan
| | - Javaid Iqbal
- Department of Paediatrics & Child Health, Aga Khan University, Karachi, Pakistan
| | - Gul Ambreen
- Department of Pharmacy, Main Pharmacy Aga Khan University Hospital, Stadium Road, P.O Box 3500, Karachi, 74800 Pakistan
| |
Collapse
|
20
|
Kalteren WS, Verhagen EA, Mintzer JP, Bos AF, Kooi EMW. Anemia and Red Blood Cell Transfusions, Cerebral Oxygenation, Brain Injury and Development, and Neurodevelopmental Outcome in Preterm Infants: A Systematic Review. Front Pediatr 2021; 9:644462. [PMID: 33718309 PMCID: PMC7952449 DOI: 10.3389/fped.2021.644462] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/08/2021] [Indexed: 12/21/2022] Open
Abstract
Background: Anemia remains a common comorbidity of preterm infants in the neonatal intensive care unit (NICU). Left untreated, severe anemia may adversely affect organ function due to inadequate oxygen supply to meet oxygen requirements, resulting in hypoxic tissue injury, including cerebral tissue. To prevent hypoxic tissue injury, anemia is generally treated with packed red blood cell (RBC) transfusions. Previously published data raise concerns about the impact of anemia on cerebral oxygen delivery and, therefore, on neurodevelopmental outcome (NDO). Objective: To provide a systematic overview of the impact of anemia and RBC transfusions during NICU admission on cerebral oxygenation, measured using near-infrared spectroscopy (NIRS), brain injury and development, and NDO in preterm infants. Data Sources: PubMed, Embase, reference lists. Study Selection: We conducted 3 different searches for English literature between 2000 and 2020; 1 for anemia, RBC transfusions, and cerebral oxygenation, 1 for anemia, RBC transfusions, and brain injury and development, and 1 for anemia, RBC transfusions, and NDO. Data Extraction: Two authors independently screened sources and extracted data. Quality of case-control studies or cohort studies, and RCTs was assessed using either the Newcastle-Ottawa Quality Assessment Scale or the Van Tulder Scale, respectively. Results: Anemia results in decreased oxygen-carrying capacity, worsening the burden of cerebral hypoxia in preterm infants. RBC transfusions increase cerebral oxygenation. Improved brain development may be supported by avoidance of cerebral hypoxia, although restrictive RBC transfusion strategies were associated with better long-term neurodevelopmental outcomes. Conclusions: This review demonstrated that anemia and RBC transfusions were associated with cerebral oxygenation, brain injury and development and NDO in preterm infants. Individualized care regarding RBC transfusions during NICU admission, with attention to cerebral tissue oxygen saturation, seems reasonable and needs further investigation to improve both short-term effects and long-term neurodevelopment of preterm infants.
Collapse
Affiliation(s)
- Willemien S Kalteren
- Division of Neonatology, Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Elise A Verhagen
- Department of Neonatology, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Jonathan P Mintzer
- Division of Newborn Medicine, Department of Pediatrics, Mountainside Medical Center, Montclair, NJ, United States
| | - Arend F Bos
- Division of Neonatology, Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Elisabeth M W Kooi
- Division of Neonatology, Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| |
Collapse
|
21
|
Zerra PE, Josephson CD. Transfusion in Neonatal Patients: Review of Evidence-Based Guidelines. Clin Lab Med 2020; 41:15-34. [PMID: 33494882 DOI: 10.1016/j.cll.2020.10.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Transfusion of red blood cells, platelets, and fresh frozen plasma in neonatal patients has not been well characterized in the literature, with guidelines varying greatly between institutions. However, anemia and thrombocytopenia are highly prevalent, especially in preterm neonates. When transfusing a neonatal patient, clinicians must take into consideration physiologic differences, gestational and postnatal age, congenital disorders, and maternal factors while weighing the risks and benefits of transfusion. This review of existing literature summarizes current evidence-based neonatal transfusion guidelines and highlights areas of current ongoing research and those in need of future studies.
Collapse
Affiliation(s)
- Patricia E Zerra
- Department of Pathology and Laboratory Medicine, Emory University Hospital, 1364 Clifton Road NE, Atlanta, GA 30322, USA; Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Egleston Hospital, 1405 Clifton Rd, Atlanta, GA 30322, USA
| | - Cassandra D Josephson
- Department of Pathology and Laboratory Medicine, Emory University Hospital, 1364 Clifton Road NE, Atlanta, GA 30322, USA; Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Egleston Hospital, 1405 Clifton Rd, Atlanta, GA 30322, USA.
| |
Collapse
|
22
|
Tao E, Ye D, Long G, Hu Y, Fu Q, Yuan T, Jiang M. Severe neonatal anemia affected by massive fetomaternal hemorrhage: a single-center retrospective observational study. J Matern Fetal Neonatal Med 2020; 35:3972-3978. [PMID: 33183095 DOI: 10.1080/14767058.2020.1845313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Massive fetomaternal hemorrhage (FMH) is a rare but sometimes life-threatening event, and surviving neonates may suffer major neurological complications. Severe neonatal anemia (SNA) affected by massive FMH is less reported in the literature. This study aims to explore the clinical characteristics, laboratory diagnoses, treatments and outcomes of SNA affected by massive FMH. METHODS Data were collected retrospectively from the hospital's electronic medical record system. All neonates born in the hospital and admitted to the neonatal unit diagnosed as SNA affected by massive FMH from 1 January 2013 to 31 June 2017 were included. RESULTS A total of 8 cases of SNA affected by FMH were identified among 6825 neonates admitted to the neonatal unit. They all presented with pallor but without hydrops at birth. Median gestational age and birthweight were 375/7 (360/7‒401/7) weeks and 2,625 (2300‒3050) g, respectively. Median hemoglobin level was 39.5 (25‒53) g/L at birth and 109.5 (94-127) g/L at discharge. Median maternal serum alpha-fetoprotein (AFP) was 3958.5 (1606‒14,330) ng/mL, which was significantly increased. Three out of eight cases manifested as antenatal decreased fetal movement. Only 1 with the lowest initial hemoglobin 25 g/L manifested as characteristic sinusoidal fetal heart rate tracing and suffered severe neonatal asphyxia and hypovolemic shock. Having experienced resuscitation, he was admitted to the neonatal unit and received twice transfusion of cross-matched red blood cells there. Another case with the initial hemoglobin 45 g/L received positive pressure ventilation and once transfusion. All cases were successfully discharged with a median hospital stay of 8 (5-12) days. Follow-up was available for 6 (75%) of 8 neonates (age range 13 months to 50 months), and all infants were observed to be in good condition with normal neurological status. In our series of eight cases, there were no neonatal deaths. CONCLUSION This study strengthens the idea that maternal AFP testing is valuable to confirm massive fetomaternal hemorrhage. Surviving neonates of massive FMH might have a good outcome despite severe anemia at birth.
Collapse
Affiliation(s)
- Enfu Tao
- Department of Gastrointestinal Lab, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.,Department of Pediatrics, Wenling Maternal and Child Health Care Hospital, Wenling, China
| | - Diya Ye
- Department of Gastrointestinal Lab, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Gao Long
- Department of Gastrointestinal Lab, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Yuting Hu
- Department of Gastrointestinal Lab, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Qibo Fu
- Office of National Clinical Research Center for Child Health, Childrens Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Tianming Yuan
- Department of Neonatology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Mizu Jiang
- Department of Gastrointestinal Lab, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.,Department of Gastroenterology, Children's Hospital, Zhejiang Universiy School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou, China
| |
Collapse
|
23
|
Flores CJ, Lakkundi A, McIntosh J, Freeman P, Thomson A, Saxon B, Parsons J, Spigiel T, Milton S, Ross B. Embedding best transfusion practice and blood management in neonatal intensive care. BMJ Open Qual 2020; 9:bmjoq-2019-000694. [PMID: 31986114 PMCID: PMC7011898 DOI: 10.1136/bmjoq-2019-000694] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 12/02/2019] [Accepted: 12/05/2019] [Indexed: 11/04/2022] Open
Abstract
Background Transfusion is a common procedure for neonates receiving intensive care management. Recognising a paucity of patient blood management (PBM) programmes in neonates, we aimed to embed blood management and best transfusion principles in the neonatal intensive care unit (NICU) by aligning local policies, providing targeted education and partnering with parents. Methods Practice-based evidence for clinical practice improvement (PBE-CPI) methodology was used. Previous hospital accreditation audits were reviewed and a neonate-specific transfusion audit was developed. Audit was performed at baseline and repeated following the intervention period. NICU clinicians received targeted education in obtaining informed consent, prescription and safe administration of blood components during a ‘Blood Month’ awareness period. A neonate-specific parent handout about transfusion was developed in partnership with parents. A pilot video demonstrating a shared consent discussion was also developed to assist in the consent process. Parents’ knowledge, concerns and feedback regarding transfusion practice was sought at baseline (survey) and on project completion (experience trackers). Results Neonate-specific baseline transfusion audit showed inconsistent consent, monitoring and documentation processes in neonatal transfusions. Post-targeted education audit showed improvement in these parameters. The targeted PBM and transfusion-related education delivered during ‘Blood Month’ was well-received by staff. Parents’ feedback about the NICU transfusion consenting process was consistently positive. NICU medical and nursing clinicians (n=25) surveyed agreed that the parent handout was well set out, easy to understand and recommended that it be used to complement practice. Conclusion PBE-CPI tools aligned with Australian PBM guidelines for clinicians and parents were well-accepted by clinical stakeholders and were associated with practice improvement in PBM awareness and transfusion consent processes. This PBE-CPI project developed NICU-specific consent information, not previously available, by partnering with parents to ensure quality of care in transfusion practice. Adoption of this also helps to meet accreditation for Australian Blood Management Standards. These strategies and tools translate readily into other NICUs to embed and support best PBM and transfusion practice.
Collapse
Affiliation(s)
- Cindy J Flores
- Clinical Services and Research Division-Transfusion Policy and Education, Australian Red Cross Lifeblood, Adelaide, South Australia, Australia
| | - Anil Lakkundi
- Neonatal Intensive Care Unit, John Hunter Children's Hospital, Newcastle, New South Wales, Australia
| | - Joanne McIntosh
- Neonatal Intensive Care Unit, John Hunter Children's Hospital, Newcastle, New South Wales, Australia
| | - Peter Freeman
- Hunter New England Local Health District, New Lambton, New South Wales, Australia
| | - Amanda Thomson
- Clinical Services and Research Division-Transfusion Policy and Education, Australian Red Cross Lifeblood, Adelaide, South Australia, Australia
| | - Ben Saxon
- Clinical Services and Research Division-Transfusion Policy and Education, Australian Red Cross Lifeblood, Adelaide, South Australia, Australia.,Women's and Children's Hospital Adelaide, North Adelaide, South Australia, Australia
| | - Justine Parsons
- Neonatal Intensive Care Unit, John Hunter Children's Hospital, Newcastle, New South Wales, Australia
| | - Tracey Spigiel
- Clinical Services and Research Division-Transfusion Policy and Education, Australian Red Cross Lifeblood, Adelaide, South Australia, Australia
| | - Sarah Milton
- The Royal Children's Hospital, Melbourne, Parkville, Victoria, Australia
| | - Bryony Ross
- Oncology and Haematology, John Hunter Children's Hospital, Newcastle, New South Wales, Australia.,Calvary Mater Hospital, Newcastle, New South Wales, Australia
| |
Collapse
|
24
|
Rocha G, Pereira S, Antunes-Sarmento J, Flôr-de-Lima F, Soares H, Guimarães H. Early anemia and neonatal morbidity in extremely low birth-weight preterm infants. J Matern Fetal Neonatal Med 2019; 34:3697-3703. [PMID: 31736385 DOI: 10.1080/14767058.2019.1689948] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Background: Extremely low birth-weight (ELBW) preterm infants remain at high risk for mortality and major morbidities, and nearly all need packed red blood cell transfusions within their first weeks of life. The overall objective of this study was to assess the association between anemia at admission to neonatal intensive care unit (NICU) with the neonatal morbidity and mortality in ELBW infants.Methods: This retrospective study was conducted on 106 patients with ELBW admitted at our level III NICU from January 2006 to December 2015. The subjects were divided into two groups: (1) patients with anemia at admission and (2) patients without anemia. Their characteristics and outcomes were compared. Statistical analysis was performed using the Statistical Package for the Social Sciences software, version 24.0 (IBM New York, USA), and a value of p < 0.05 was considered statistically significant.Results: Of the 106 ELBW, 34 (32%) presented with anemia at admission and 72 (68%) without anemia. Anemia-naive presented mean hemoglobin at the admission of 12.8 ± 1.5 g/dl and nonanemic 16.8 ± 2.1 g/dl, p < .001). The anemic group presented a lower gestational age (26 ± 2 vs. 27 ± 2 SD weeks, p = .025), greater need for inotropic support (52.9 vs. 31.9%, p = .041), longer period of invasive mechanical ventilation (9 vs. 2 days, p = .012), higher FiO2 need (0.8 vs. 0.4, p < .001), more frequent hemodynamically significant patent ductus arteriosus (HS-PDA) (64.7 vs. 41.7%, p = .006) and severe intra-periventricular hemorrhage (IPVH) (41.2 vs. 16.7%, p = 0.005). The multivariate analysis confirmed an association between anemia at admission and HS-PDA (OR = 3.2; 95% CI: 1.1-9.5, p = 0.044) and severe IPVH (OR = 3.3; 95% CI: 1.0-9.9, p = .038). In anemic infants, ionotropic support and IPVH >2 were considered independent factors for mortality.Conclusion: In this ELBW series, the presence of anemia at admission to the NICU was associated with HS-PDA and severe IPVH. Preventive strategies for early anemia must be encouraged.
Collapse
Affiliation(s)
- Gustavo Rocha
- Department of Pediatrics, Neonatal Intensive Care Unit, Centro Hospitalar, Universitário São João, Porto, Portugal
| | - Sandra Pereira
- Department of Pediatrics, Neonatal Intensive Care Unit, Centro Hospitalar, Universitário São João, Porto, Portugal
| | - João Antunes-Sarmento
- Department of Pediatrics, Neonatal Intensive Care Unit, Centro Hospitalar, Universitário São João, Porto, Portugal
| | - Filipa Flôr-de-Lima
- Department of Pediatrics, Neonatal Intensive Care Unit, Centro Hospitalar, Universitário São João, Porto, Portugal.,Faculty of Medicine, Porto University, Porto, Portugal
| | - Henrique Soares
- Department of Pediatrics, Neonatal Intensive Care Unit, Centro Hospitalar, Universitário São João, Porto, Portugal.,Faculty of Medicine, Porto University, Porto, Portugal
| | - Hercília Guimarães
- Department of Pediatrics, Neonatal Intensive Care Unit, Centro Hospitalar, Universitário São João, Porto, Portugal.,Faculty of Medicine, Porto University, Porto, Portugal
| |
Collapse
|
25
|
Progressive anemia of prematurity is associated with a critical increase in cerebral oxygen extraction. Early Hum Dev 2019; 140:104891. [PMID: 31669878 PMCID: PMC7180102 DOI: 10.1016/j.earlhumdev.2019.104891] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 09/12/2019] [Accepted: 09/24/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Elevated cerebral fractional tissue oxygen extraction (cFTOE) is an adaptation to anemia of prematurity (AOP). cFTOE ≥0.4 is associated with brain injury in infants ≤30 weeks. This longitudinal study sought to investigate the utility of cFTOE in the evaluation of AOP. METHODS Infants ≤30 weeks estimated gestational age (EGA) underwent weekly hemoglobin, cerebral saturation, and pulse oximetry recordings from the second through 36 weeks post-menstrual age (PMA). Recordings were excluded if they were under 1 h or if hemoglobin was not measured within 7 days of recording. Mean cFTOE was calculated for each recording. Statistical analysis used linear mixed-effects modeling and receiver operating characteristic analysis. RESULTS 144 recordings from 39 infants (mean EGA 27.6 ± 2.2 weeks, BW 1139 ± 286 g) were included of whom 39% (15/39) were transfused. The mean recording length was 2.8 ± 1.3 h. There was a significant negative correlation between hemoglobin and cFTOE (R = -0.423, p ≤.001). In a multivariate model, adjusting for EGA, PMA, and patent ductus arteriosus treatment the AUC was 0.821. A critical increase in cFTOE occurred at a hemoglobin level of 9.6 g/dL. CONCLUSIONS AOP is associated with a critical increase in cFTOE that occurs at a significantly higher hemoglobin level than standard clinical thresholds for transfusion.
Collapse
|
26
|
Abstract
Pre-term infants have one of the highest transfusion requirements within the hospital-setting. The vast majority of blood transfusions performed in Neonatal Intensive Care Units (NICUs) are for medically stable pre-term infants with anaemia of prematurity, with the aim of improving oxygen delivery to the vital organs during the crucial phase of growth and development. However, despite the frequency of transfusion in this population, the potential benefits and harms of 'top up' transfusion are not fully understood, leading to practice variation between clinicians, institutions and countries. Significant advances have been made in the prevention of anaemia of prematurity, with recent emphasis on optimising infants' circulatory volume at birth via placental transfusion and preserving infants' own blood volume through innovative minimal sampling techniques. More research is urgently needed to establish optimal transfusion thresholds for these high-risk pre-term infants, for whom benefits as well as adverse outcomes may have consequences that extend for decades throughout the recipients' life-course. In this review, we will discuss some of the consensus and controversies regarding optimal management of anaemia in pre-term infants and highlight potential areas for future research.
Collapse
Affiliation(s)
- Maria Saito-Benz
- Neonatal Intensive Care Unit, Wellington Regional Hospital, Wellington, New Zealand.,Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand
| | | | - Mary J Berry
- Neonatal Intensive Care Unit, Wellington Regional Hospital, Wellington, New Zealand.,Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand.,Centre for Translational Physiology, University of Otago, Wellington, New Zealand
| |
Collapse
|
27
|
Chang MR, Chon AH, Baskin J, Nael A, Chmait RH. Case 1: Cardiac Arrest in a 2-month-old Boy with a Prenatal Course Complicated by Alloimmunization. Pediatr Rev 2019; 40:243-246. [PMID: 31043443 DOI: 10.1542/pir.2018-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | - Andrew H Chon
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology
| | - Jacquelyn Baskin
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA.,Children's Center for Cancer and Blood Disease
| | - Ali Nael
- Department of Pediatrics.,Department of Pathology, Children's Hospital Los Angeles, Los Angeles, CA
| | - Ramen H Chmait
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology
| |
Collapse
|
28
|
Saito-Benz M, Sandle ME, Jackson PB, Berry MJ. Blood transfusion for anaemia of prematurity: Current practice in Australia and New Zealand. J Paediatr Child Health 2019; 55:433-440. [PMID: 30246273 DOI: 10.1111/jpc.14222] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 06/20/2018] [Accepted: 08/19/2018] [Indexed: 12/13/2022]
Abstract
AIM To characterise the current transfusion practice among clinicians in Australasian neonatal units and factors that influence their decision-making. METHODS Members of the Australia and New Zealand Neonatal Network (ANZNN) and practitioners at their local institutions were invited to participate in a 15-question web-based survey between 1 June and 31 July 2016. The survey was designed to assess (i) haemoglobin-based transfusion thresholds; (ii) presence of local guidelines; (iii) preference for a restrictive or liberal transfusion policy; (iv) perceived benefits and risks of transfusion; and (v) use of clinical adjuncts to assist decision-making. RESULTS Overall, 130 participants responded to at least one question. Haemoglobin transfusion thresholds for anaemia of prematurity (AOP) varied significantly from <60 to <120 g/L. Of 103 participants, 36 (35%) reported that they do not have access to local transfusion guidelines. The majority utilise multiple clinical and haematological parameters to guide their decision-making, and approximately half (45/84, 54%) believe that tissue hypoxia detected by near-infrared spectroscopy (NIRS) may better inform transfusion thresholds. Of 102 participants, 51 (50%) support a restrictive rather than liberal transfusion policy. The most commonly reported perceived risks of transfusion for AOP were suppression of endogenous erythropoiesis and increased rates of necrotising enterocolitis. CONCLUSIONS There is a significant variation in transfusion practice in Australasian neonatal units. Quality and safety initiatives may assist with improved consistency of transfusion practice across the ANZNN. However, further research is required to better define optimal transfusion thresholds, quantify potential risks of transfusion and determine clinical utility of newer adjuncts such as NIRS.
Collapse
Affiliation(s)
- Maria Saito-Benz
- Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand.,Neonatal Intensive Care Unit, Wellington Regional Hospital, Wellington, New Zealand
| | - Meghan E Sandle
- Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand
| | - Paul B Jackson
- Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand.,Neonatal Intensive Care Unit, Wellington Regional Hospital, Wellington, New Zealand
| | - Mary J Berry
- Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand.,Neonatal Intensive Care Unit, Wellington Regional Hospital, Wellington, New Zealand
| |
Collapse
|
29
|
Severe haematologic toxicity is rare in high risk HIV-exposed infants receiving combination neonatal prophylaxis. HIV Med 2019; 20:291-307. [PMID: 30844150 DOI: 10.1111/hiv.12696] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Combination neonatal prophylaxis (CNP) is recommended in high-risk situations for the prevention of mother-to-child HIV transmission, although data on its safety are limited. The aim of the study was to identify whether neonatal prophylaxis (NP) type is associated with the risk of severe anaemia or neutropaenia. METHODS An individual patient data meta-analysis was conducted within six European cohorts, in infants at high risk for acquiring HIV infection. Adjusted logistic regression models were used to assess the risk of National Institute of Allergy and Infectious Diseases, Division of AIDS (DAIDS) grade 3-4 anaemia/neutropaenia at ages 0-6 months. Mixture models of haemoglobin (Hb) level and log10 -transformed neutrophil count (NC) were used to explore associations with NP type at ages 0-18 months. RESULTS Of 1836 infants, 25% were preterm, 1149 (63%) had antenatal combination antiretroviral therapy (cART) exposure and 395 (22%) received NP (125 received CNP with three drugs). Overall, 117 (6.7%) infants had grade 3-4 anaemia at age 0-6 months and 140 (9.1%) had grade 3-4 neutropaenia. The presence of grade 3-4 anaemia or neutropaenia was not associated with NP type [adjusted odds ratio (aOR) 1.04 for one-drug NP and 1.60 for three-drug NP versus two-drug NP (P = 0.879 and P = 0.277, respectively) for anaemia; aOR 1.33 for one-drug NP and 1.98 for three-drug NP versus two-drug NP (P = 0.330 and P = 0.113, respectively) for neutropaenia], but was associated with preterm delivery. Overall, 7746 Hb and NC results were available for 1836 infants up to age 18 months; no significant differences in predicted Hb level or NC were apparent by NP type. CONCLUSIONS A small proportion of infants experienced grade 3-4 haematological adverse events; risk of anaemia or netropenia was not associated with type of NP.
Collapse
|
30
|
Whitehead HV, Vesoulis ZA, Maheshwari A, Rao R, Mathur AM. Anemia of prematurity and cerebral near-infrared spectroscopy: should transfusion thresholds in preterm infants be revised? J Perinatol 2018; 38:1022-1029. [PMID: 29740185 PMCID: PMC6136959 DOI: 10.1038/s41372-018-0120-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 03/03/2018] [Accepted: 03/12/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To determine the impact of progressive anemia of prematurity on cerebral regional saturation (C-rSO2) in preterm infants and identify the hemoglobin threshold below which a critical decrease (>2SD below the mean) in C-rSO2 occurs. STUDY DESIGN In a cohort of infants born ≤30 weeks EGA, weekly C-rSO2 data were prospectively collected from the second week of life through 36 weeks post-menstrual age (PMA). Clinically obtained hemoglobin values were noted at the time of recording. Recordings were excluded if they were of insufficient duration (<1 h) or if the hemoglobin was not measured within 7 days. Statistical analysis was performed using a linear mixed effects-model and ROC analysis. ROC analysis was used to determine the threshold of anemia, where C-rSO2 critically decreased >2SD below the mean normative value (<55%) in preterm infants. RESULTS In total 253 recordings from 68 infants (mean EGA 26.9 ± 2.1 weeks, BW 1025 ± 287 g, 49% male) were included. Approximately 29 out of 68 infants (43%) were transfused during hospitalization. Mixed-model statistical analysis adjusting for EGA, BW, and PMA revealed a significant association between decreasing hemoglobin and C-rSO2 (p < 0.01) in transfusion-naive infants but not in transfused infants. In the transfusion naive group, using ROC analysis demonstrated a threshold hemoglobin of 9.5 g/dL (AUC 0.81, p < 0.01) for critical cerebral desaturation in preterm infants. CONCLUSIONS In transfusion-naive preterm infants, worsening anemia was associated with a progressive decrease in cerebral saturations. Analysis identified a threshold hemoglobin of 9.5 g/dL below which C-rSO2 dropped >2SD below the mean.
Collapse
Affiliation(s)
- Halana V. Whitehead
- Department of Pediatrics, Division of Newborn Medicine, Washington University School of Medicine
| | - Zachary A. Vesoulis
- Department of Pediatrics, Division of Newborn Medicine, Washington University School of Medicine
| | - Akhil Maheshwari
- Department of Pediatrics, Division of Neonatology, University of South Florida Morsani College of Medicine
| | - Rakesh Rao
- Department of Pediatrics, Division of Newborn Medicine, Washington University School of Medicine
| | - Amit M. Mathur
- Department of Pediatrics, Division of Newborn Medicine, Washington University School of Medicine
| |
Collapse
|
31
|
Abstract
OBJECTIVES To verify the reliability and clinical benefits of the coagulation tests made by a point of care device in newborn admitted to a neonatal unit. DESIGN We made a statistical comparison between results obtained by the point of care device versus conventional laboratory analysis. SETTING Level 3 neonatal unit. PATIENTS Thirty-one infants admitted to the neonatal unit at the San Cecilio University Hospital (Granada, Spain) were recruited to this study. INTERVENTIONS All underwent a double analytical determination: a small drop of blood was taken for analysis with a portable coagulometer (qLabs Electrometer Plus) and the rest of the blood sample was analyzed with conventional hospital laboratory equipment. MEASUREMENTS AND MAIN RESULTS According to the linearity test performed, the measuring methods presented a good linear regression fit. Lin's concordance coefficient showed a "good" agreement for activated partial prothrombin time and international normalized ratio (>0.61) and a moderate one for prothrombin time (0.41-0.6) for the sample of newborns. CONCLUSIONS The portable coagulometer qLabs Electrometer Plus device has the potential to be an alternative to standard hospital coagulation autoanalyzers in a subset of patients where the amount of blood drawn can have significant risks. Our study is the first of its kind to analyze the use of this device with severely ill newborns.
Collapse
|
32
|
Wang ZL, Du LZ, Chen YY, Li LQ, Lu Q, Liu Y, Cao LY, He Y, Yu JL. Analysis of the characteristics and management of critical values in a newborn tertiary center in China. World J Pediatr 2017; 13:49-56. [PMID: 27650526 DOI: 10.1007/s12519-016-0058-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Accepted: 05/29/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Critical value reporting has been widely adopted by hospitals throughout the world, but there were few reports about neonatal critical values. This study aimed to analyze characteristics of the neonatal critical values considered at our center and to provide information on improving neonatal intensive care. METHODS A retrospective study of critical values at a newborn tertiary center in China was conducted to assess neonatal critical values according to test, distribution, reporting time, patient outcome and the impact to the therapy. RESULTS In total, 926 critical values were recorded. Overall, 66.52% (616/926) of the items were reported within 24 hours of admission, 50.28% (465/926) during duty times and 54.75% (507/926) in the neonatal intensive care unit (NICU). The routine coagulation test was the most frequent source of critical values. Electrocardiography, blood gas analysis and therapeutic drug monitoring of drug levels were associated with the highest rates of treatment intervention (100%); routine coagulation tests were the lowest (23.14%). Sample quality was the main cause of false-positive critical values. CONCLUSIONS The incidence of neonatal critical values peaked during the first 24 hours post-admission and during duty periods. Each newborn center needs to enact rapid treatment guidelines to address common critical values in order to facilitate clinical interventions. Periodically reviewing critical values could help to optimize clinical practices.
Collapse
Affiliation(s)
- Zheng-Li Wang
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics in Chongqing and Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, No.136 Zhongshan 2nd Road, Yuzhong District, Chongqing, China
| | - Li-Zhong Du
- Department of Neonatology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yi-Yu Chen
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics in Chongqing and Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, No.136 Zhongshan 2nd Road, Yuzhong District, Chongqing, China
| | - Lu-Quan Li
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics in Chongqing and Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, No.136 Zhongshan 2nd Road, Yuzhong District, Chongqing, China
| | - Qi Lu
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics in Chongqing and Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, No.136 Zhongshan 2nd Road, Yuzhong District, Chongqing, China
| | - Ying Liu
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics in Chongqing and Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, No.136 Zhongshan 2nd Road, Yuzhong District, Chongqing, China
| | - Lu-Ying Cao
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics in Chongqing and Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, No.136 Zhongshan 2nd Road, Yuzhong District, Chongqing, China
| | - Yu He
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics in Chongqing and Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, No.136 Zhongshan 2nd Road, Yuzhong District, Chongqing, China
| | - Jia-Lin Yu
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics in Chongqing and Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, No.136 Zhongshan 2nd Road, Yuzhong District, Chongqing, China.
- , No.136 Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014, China.
| |
Collapse
|
33
|
Loureiro B, Martinez-Biarge M, Foti F, Papadaki M, Cowan FM, Wusthoff CJ. MRI Patterns of brain injury and neurodevelopmental outcomes in neonates with severe anaemia at birth. Early Hum Dev 2017; 105:17-22. [PMID: 28107673 DOI: 10.1016/j.earlhumdev.2017.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 12/31/2016] [Accepted: 01/04/2017] [Indexed: 10/20/2022]
Abstract
AIMS To define patterns of brain injury and associated neurodevelopmental outcomes in infants with severe neonatal anaemia. METHODS We studied 20 infants with severe anaemia at birth (haemoglobin<7g/dL). Clinical details were analysed for causes of anaemia and co-morbidities. All had early brain magnetic resonance imaging (MRI) scans, which were reviewed for injury pattern. Neurodevelopmental outcomes were assessed at a median age of 24months. RESULTS The aetiology of the anaemia was feto-maternal haemorrhage in 17 and antepartum haemorrhage in 3 infants. The predominant site of injury was the white matter, which was affected in all infants, with differing grades of severity and with cystic evolution in 45%. Only one infant showed an injury pattern typical of an acute severe hypoxic-ischaemic insult. Outcomes correlated closely to the severity of MRI findings. Cerebral palsy was seen only with the most severe neuroimaging patterns (n=6). Global developmental delay, learning or behavioural problems and seizures were common with moderate injury. Visual impairment occurred, particularly with posterior injury. Microcephaly developed in 45%. INTERPRETATION Severe neonatal anaemia at birth was associated with a white matter predominant pattern of injury, the severity of which was related to neurodevelopmental outcomes. Early MRI and long-term follow-up are advisable following severe neonatal anaemia.
Collapse
Affiliation(s)
- Begoña Loureiro
- Departamento de Pediatría, Hospital Universitario Cruces, Barakaldo, Spain.
| | | | - Francesca Foti
- Department of Mental Health, Azienda Unita Sanitaria Locale di Reggio Emilia, Emilia-Romagna, Italy
| | - Maria Papadaki
- Own private paediatrician practice, Cholargos Attica, Greece
| | - Frances M Cowan
- Department of Paediatrics, Hammersmith Hospital, Imperial College, London, UK
| | | |
Collapse
|
34
|
Sottas CE, Cumin D, Anderson BJ. Blood pressure and heart rates in neonates and preschool children: an analysis from 10 years of electronic recording. Paediatr Anaesth 2016; 26:1064-1070. [PMID: 27515457 DOI: 10.1111/pan.12987] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/11/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND An acceptable systolic or mean arterial blood pressure for children 0-6 years during anesthesia is unknown. Accepted blood pressures reported in standard charts for healthy awake children may not apply to those undergoing anesthesia. AIM Our goal was to define observed blood pressures (BP) and heart rate (HR) in children 0-5 years during anesthesia. METHODS Data from the electronic health record database were available for a 10-year period from June 29, 2005 to July 22, 2015. A simple band-pass filter was applied to remove artifact in the physiologic time-series data for heart rate and blood pressure, with heart rate values 40 or above 250, mean or diastolic blood pressures below 20 or above 200, and systolic blood pressures below 30 or above 200 all excluded. For each anesthetic, the centiles of physiological variables (BP, HR) were calculated. RESULTS Data were available for 54 896 anesthetics in children 6 years and younger. There were 898 anesthesia reports available that included blood pressure measures immediately before induction. A larger number of anesthesia records (n = 30 008) were available for intraoperative blood pressure recording. The BP decrease after anesthesia induction was most pronounced in infants 0-10 weeks of age where there was a mean arterial blood pressure (MAP) decrease of 16.6-34.5% (mean 28.6%). Systolic blood pressure decreased by 16.3-32.6% (mean 25.5%). Values above a systolic blood pressure of 60 mm Hg were only noted in half the neonates during anesthesia. Heart rates, both before and after anesthesia induction, were similar. CONCLUSION Heart rate while under anesthesia appears a poor indicator for blood pressure changes. Recorded blood pressures in this current study, measured immediately before induction, were consistent with those in the literature. A mean MAP decrease of 28.6% was typical in those infants 0-10 weeks of age.
Collapse
Affiliation(s)
- Cedric E Sottas
- Paediatric Anaesthesia Department, Auckland Children's Hospital, Auckland, New Zealand
| | - David Cumin
- Department of Anaesthesiology, Auckland University, Auckland, New Zealand
| | - Brian J Anderson
- Paediatric Anaesthesia Department, Auckland Children's Hospital, Auckland, New Zealand. .,Department of Anaesthesiology, Auckland University, Auckland, New Zealand.
| |
Collapse
|
35
|
Visram AR. Intraoperative fluid therapy in neonates. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2016. [DOI: 10.1080/22201181.2016.1140705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
36
|
Abstract
Neonatal anemia is a frequent occurrence in neonatal intensive care units. Red blood cell transfusion criteria in case of blood loss are clearly defined but optimal hemoglobin or hematocrit thresholds of transfusion for anemia due to decreased production or increased destruction are less evident. This review focuses on the causes of anemia in the newborn period and the most recent evidence-based treatment options, including transfusion and erythropoiesis-stimulating agents.
Collapse
Affiliation(s)
- Raffaella Colombatti
- Clinic of Pediatric Hematology Oncology, Department of Child and Maternal Health, Azienda Ospedaliera - University of Padova, Padova, Italy.
| | - Laura Sainati
- Clinic of Pediatric Hematology Oncology, Department of Child and Maternal Health, Azienda Ospedaliera - University of Padova, Padova, Italy
| | - Daniele Trevisanuto
- Neonatology Intensive Care Unit, Department of Child and Maternal Health, Azienda Ospedaliera - University of Padova, Padova, Italy
| |
Collapse
|
37
|
Alan S, Arsan S. Prevention of the anaemia of prematurity. Int J Pediatr Adolesc Med 2015; 2:99-106. [PMID: 30805447 PMCID: PMC6372412 DOI: 10.1016/j.ijpam.2015.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 10/26/2015] [Accepted: 10/29/2015] [Indexed: 02/08/2023]
Abstract
Despite recent advances in neonatal and perinatal medicine, extremely low birth weight infants (ELBW) are at high risk of developing anaemia of prematurity (AOP) requiring packed red blood cell (RBC) transfusions. The benefit of transfusing allogenic RBCs for AOP is a controversial issue, except for disturbances in tissue oxygenation. Although the role of erythropoietin (EPO) in the pathophysiology of AOP is well known, neither early nor late recombinant human EPO therapy alters the number or volume of RBC transfusions. It is also known that one-half of the feto-placental blood volume remains outside the newborn infant's circulation at 30 weeks of gestation if the umbilical cord is clamped immediately. Delayed cord clamping (DCC) and umbilical cord milking (UCM) are the main methods for enhancing placental transfusion. The basic principle of these approaches depends on providing high haemoglobin (Hb) levels to premature infants in the delivery room. The enhancement of placental transfusion clearly results in higher Hb levels at birth, reducing the need for RBC transfusions as well as creating a better haemodynamic status during the initial hours of life. To date, enhancement of placental transfusion in the delivery room by either DCC or UCM seems to be the best preventive measure for AOP. Yet, studies on the associated neurodevelopmental outcomes are insufficient to reach a conclusion. This review summarizes the pathophysiology, treatment and preventative strategies of anaemia of prematurity in light of the current literature.
Collapse
Affiliation(s)
- Serdar Alan
- Division of Neonatology, Department of Pediatrics, Yuksek Ihtisas University School of Medicine, Ankara, Turkey
| | - Saadet Arsan
- Division of Neonatology, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
| |
Collapse
|
38
|
Yamada RT, Leone CR. Hematological and iron content evolution in exclusively breastfed late-preterm newborns. Clinics (Sao Paulo) 2014; 69:792-8. [PMID: 25627989 PMCID: PMC4286666 DOI: 10.6061/clinics/2014(12)01] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 08/25/2014] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES To analyze and compare the evolution of hematological parameters and body iron content between exclusively breastfed late-preterm and term newborns during the first two months of life. METHODS Cohort study. Weight, length, head circumference, body mass index, hemoglobin, hematocrit, reticulocytes, total iron-binding capacity, transferrin saturation, serum iron and ferritin were measured in 25 late-preterm and 21 term newborns (at birth and at one and two months of age) who were exclusively breastfed. STATISTICAL ANALYSIS Kolmogorov-Smirnov test, one-way ANOVA or Kruskal-Wallis test; and Student's t-test or Mann-Whitney test. SIGNIFICANCE p<0.05. RESULTS The corrected gestational ages of the late-preterm infants were 39.98 weeks at one month of life and 44.53 weeks at two months. Anthropometric measures and the body mass index increased over time (p<0.001) and hemoglobin, hematocrit, reticulocytes and body iron content decreased (p<0.001). Late-preterm infants at term corrected gestational age had reduced hemoglobin, hematocrit and reticulocyte concentrations, and reduced total iron-binding capacity (p<0.001) and serum iron (p=0.0034) compared with values observed in term newborns at birth. Late-preterm newborns at a corrected gestational age of one month post-term had hemoglobin (p=0.0002), hematocrit (p=0.0008), iron (p<0.0001) and transferrin saturation (p<0.001) levels lower than those of term newborns at one month of age and a higher total iron-binding capacity (p=0.0018). Ferritin did not differ between the groups. CONCLUSION Exclusively breastfed late-preterm newborns presented greater reductions in hemoglobin/hematocrit and lower iron stores at a corrected gestational age of one month post-term than did term newborns, suggesting specific iron supplementation needs.
Collapse
Affiliation(s)
- Renato Takeshi Yamada
- Faculdade de Medicina da Universidade de São Paulo, Department of Pediatrics, São Paulo/SP, Brazil
- corresponding author:
| | | |
Collapse
|
39
|
Garcia-Serrano JL, Uberos Fernández J, Anaya-Alaminos R, Jerez-Calero A, Padilla-Torres JF, Ramírez-Garcia MC, Piñar-Molina R. "Oxygen with love" and diode laser treatment decreases comorbidity and avoidable blindness due to retinopathy of prematurity: results achieved in the past 12 years. Pediatr Neonatol 2013; 54:397-401. [PMID: 23810719 DOI: 10.1016/j.pedneo.2013.05.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Revised: 04/11/2013] [Accepted: 05/22/2013] [Indexed: 12/17/2022] Open
Abstract
AIM To determine whether the "Oxygen with Love" (OWL) and diode laser treatment provided in a neonatal intensive care unit has reduced the risk of avoidable blindness caused by retinopathy of prematurity (ROP) over the past decade. MATERIALS AND METHODS A prospective observational cohort study was performed, in which 351 infants were examined for ROP. The inclusion conditions were as follows: preterm infants, birthweight <1500 g or <32 weeks' gestational age, and birth between 1 Jan 2000 to 31 August 2012. From mid-2009, the OWL program was implemented and the ventilation protocols for such infants were amended. We tested whether the incidence of unfavorable structural outcomes of ROP had decreased following these changes. RESULTS From 2004 to 2012, the survival rates of younger children increased (p < 0.003). From 2005 to 2012, laser treatment rather than cryotherapy was applied, and the incidence of unfavorable structural outcomes of ROP fell from 13% to 5.6% (not significant). From 2009 to 2012, the incidence of ROP decreased from 55% to 29% (p < 0.002). From 1 August 2009 to 31 August 2012, there was less need for ablative treatment for premature infants, with the rate falling from 11.81% to 3.9% (p < 0.03). This improvement was significantly associated with a reduction in the number of days of intubation (p < 0.0017), lower rates of sepsis (p < 0.003), and improvements in postnatal weight gain (p < 0.0002). CONCLUSION The introduction of the OWL program, together with lower rates of sepsis, improvements in postnatal weight gain, and the use of diode laser treatment, has reduced the incidence of unfavorable structural outcomes of ROP.
Collapse
|
40
|
Iron deficiency and anemia in iron-fortified formula and human milk-fed preterm infants until 6 months post-term. Eur J Nutr 2013; 53:1263-71. [PMID: 24292818 DOI: 10.1007/s00394-013-0629-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Accepted: 11/20/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE An iron intake of >2 mg/kg/d is recommended for preterm infants. We hypothesized that human milk (HM)-fed preterm infants require iron supplementation after discharge, whereas iron-fortified formulae (IFF; 0.8-1.0 mg iron/100 ml) may provide sufficient dietary iron until 6 months post-term. METHODS At term age, 3 and 6 months post-term, ferritin (μg/l) was measured in 92 IFF-fed infants (gestational age (median (interquartile range)) 30.7 (1.4) weeks, birth weight 1,375 (338) gram) and 46 HM-fed infants (gestational age 30.0 (1.7) weeks, birth weight 1,400 (571) gram). Iron intake (mg/kg/d) between term age and 6 months post-term was calculated. RESULTS Iron was supplemented to 71.7% of HM-fed and 83.7% of IFF-fed infants between term age and 3 months post-term and to 13% of HM-fed and 0% of IFF-fed infants between 3 and 6 months post-term. IFF-fed infants had an iron intake from supplements and formula of 2.66 (1.22) mg/kg/d between term age and 3 months post-term and 1.19 (0.32) mg/kg/d between 3 and 6 months post-term. At 3 and 6 months post-term, the incidence of ferritin <12 μg/l was higher in HM-fed compared to IFF-fed infants (23.8 vs. 7.8% and 26.3 vs. 9.5%, P < 0.02). CONCLUSION This observational study demonstrates that ferritin <12 μg/l is more prevalent in HM-fed infants until 6 months post-term. This may be due to early cessation of additional iron supplementation. We speculate that additional iron supplementation is not necessary in preterm infants fed IFF (0.8-1.0 mg iron/100 ml), as they achieve ferritin ≥12 μg/l without additional iron supplements between 3 and 6 months post-term.
Collapse
|
41
|
Abstract
Necrotizing enterocolitis (NEC) is a disease primarily of prematurity characterized by partial or entire gut necrosis and is associated with significant mortality and morbidity. Recent studies report that approximately 25% to 35% of very low-birth-weight infants less than 1500 g receiving packed red blood cell transfusions develop temporally associated NEC, known as transfusion-related NEC (TR-NEC). Although there are many known risk factors for NEC, this article focuses on 3 contributing factors: packed red blood cell transfusions, enteral feedings, and gastrointestinal immaturity. Previous data suggest that these factors may interact to affect neonatal intestinal tissue oxygenation, which may lead to tissue ischemia, resulting in intestinal injury. This article presents a conceptual framework that combines current theoretical perspectives for TR-NEC, and reviews previous research examining related variables and how their interaction may increase the risk for TR-NEC development. In addition, incorporation of the proposed framework to guide future research and nursing care in this area is discussed.
Collapse
|
42
|
Abstract
PURPOSE Anemia of prematurity is frequent in preterm infants, for which red blood cell (RBC) transfusion remains the treatment of choice. In this study, we attempted to evaluate the characteristics and risk factors of anemia of prematurity, and suggest ways to reduce anemia and the need for multiple transfusions. MATERIALS AND METHODS Preterm infants weighing less than 1500 g (May 2008-May 2009) were divided into two groups depending on whether they received RBC transfusions (transfusion group and non transfusion group). Hemoglobin (Hb) concentration, phlebotomy blood loss, and the amount of RBC transfusion were analyzed. Risk factors of anemia and RBC transfusions were analyzed. RESULTS Fifty infants that survived were enrolled in the present study: 39 in the transfusion group and 11 in the non transfusion group. Hb concentrations gradually decreased by eight weeks. In the transfusion group, gestational age and birth weight were smaller, bronchopulmonary dysplasia and sepsis were more frequent, full feeding was delayed, parenteral nutrition and days spent in the hospital were prolonged, and phlebotomy blood loss was greater than that in the non transfusion group. CONCLUSION Anemia of prematurity was correlated with increased laboratory blood loss, decreased birth weight, prolonged parenteral nutrition, and delayed body weight gain. Accordingly, reducing laboratory phlebotomy loss and parenteral nutrition, as well as improving body weight gain, may be beneficial to infants with anemia of prematurity.
Collapse
Affiliation(s)
- Ga Won Jeon
- Department of Pediatrics, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jong Beom Sin
- Department of Pediatrics, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| |
Collapse
|
43
|
Arri SJ, Muehlemann T, Biallas M, Bucher HU, Wolf M. Precision of cerebral oxygenation and hemoglobin concentration measurements in neonates measured by near-infrared spectroscopy. JOURNAL OF BIOMEDICAL OPTICS 2011; 16:047005. [PMID: 21529095 DOI: 10.1117/1.3570303] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
BACKGROUND AND AIM One source of error with near-infrared spectroscopy (NIRS) is the assumption that the measured tissue is optically homogeneous. This is not always the case. Our aim is to assess the impact of tissue homogeneity (TH) on the precision of NIRS measurements in neonates. METHODS On 36 term and 27 preterm neonates at least five 1-min measurements are performed on each subject using the OxiplexTS. The sensor position is slightly changed before each measurement while assessing TH. The precision for cerebral tissue oxygenation saturation (StO(2)) and total hemoglobin concentration (tHb) are calculated by repeated measures analysis of variance. RESULTS The mean StO(2) is not significantly different between term and preterm infants. The mean tHb is significantly lower in preterm infants (p < 0.01). With increasing TH, the precision of StO(2) increase from 5.6 to 4.6% for preterm and from 11.0 to 2.0% for term infants; the precision of tHb increases from 10.1 to 7.5μM for preterm and from 16.4 to 3.5 μM for term infants. The precision for StO(2) is higher in term than in preterm infants. The precision for tHb shows no significant difference between the two groups. CONCLUSIONS The precision of NIRS measurements correlates with tissue homogeneity.
Collapse
Affiliation(s)
- Sandra Jasminder Arri
- Department of Obstetrics and Gynecology, University Hospital Zurich, Clinic of Neonatology, Frauenklinikstrasse 10, 8091 Zurich, Switzerland
| | | | | | | | | |
Collapse
|
44
|
Jang DG, Jo YS, Lee SJ, Lee GSR. Risk factors of neonatal anemia in placenta previa. Int J Med Sci 2011; 8:554-7. [PMID: 21960747 PMCID: PMC3180771 DOI: 10.7150/ijms.8.554] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Accepted: 09/14/2011] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Placenta previa is a major cause of neonatal anemia. The purpose of this study was to elucidate the risk factors of neonatal anemia in placenta previa. METHODS The study was conducted on 158 placenta previa patients at 3 hospitals in affiliation with the Catholic Medical Center, Seoul, Korea from May 1999 through December 2009. The subjects were divided in to 2 groups: 47 placenta previa patients with neonatal anemia, and 113 placenta previa patients without neonatal anemia. The subjects' characteristics were compared. Logistic regression was used to control for confounding factors. RESULTS Anterior placental location (OR 2.48; 95% CI: 1.20-5.11) was an independent risk factor of neonatal anemia after controlling for potential confounders. CONCLUSION To manage neonatal anemia in placenta previa patients, obstetricians should do their best to detect placental location. Pediatricians should consider the high possibility of neonatal anemia in cases involving anterior placental location.
Collapse
Affiliation(s)
- Dong Gyu Jang
- Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea
| | | | | | | |
Collapse
|
45
|
|