Abstract
ObjectiveTo determine whether there is a significant association between maternal haemoglobin measured before delivery and short-term neonatal outcome in very preterm neonates.Study designWe included prospectively all live births occurring from 25 to 32+6 weeks of gestation in a tertiary care centre between January 1st 2009 and December 31st 2011. Outborn infants and infants presenting with lethal malformations were excluded. Three hundred and thirty-nine mothers and 409 infants met the inclusion criteria. For each mother-infant pair a prospective record of epidemiologic data was performed and maternal haemoglobin concentration recorded within 24 hours before delivery was retrospectively researched. Maternal haemoglobin was divided into quartiles with the second and the third one regarded as reference as they were composed of normal haemoglobin values. Short-term outcome was defined as poor in case of death during hospital stay and/or grades III/IV intraventricular haemorrhage and/or periventricular leukomalacia and/or necessity of ventriculoperitoneal shunt.ResultsThe global rate of poor short-term neonatal outcome was 11.4% and was significantly associated with low maternal haemoglobin values. This association remained significant after adjustment for antenatal corticosteroids therapy, gestational age, parity, mechanism of preterm birth, mode of delivery and birth weight (aOR = 2.97 CI 95% [1.36–6.47]). There was no relation between short-term neonatal outcome and high maternal haemoglobin concentration values.ConclusionWe show that low maternal haemoglobin concentration at delivery is an independent risk factor for poor short-term neonatal outcome in very preterm neonates. This study is one of the first to show such an association within the preterm population.
Highlights
Preterm delivery accounts for 75% of perinatal mortality and more than half of long-term morbidity.[1]
The global rate of poor short-term neonatal outcome was 11.4% and was significantly associated with low maternal haemoglobin values. This association remained significant after adjustment for antenatal corticosteroids therapy, gestational age, parity, mechanism of preterm birth, mode of delivery and birth weight
There was no relation between short-term neonatal outcome and high maternal haemoglobin concentration values
Summary
Preterm delivery accounts for 75% of perinatal mortality and more than half of long-term morbidity.[1] Its overall incidence keeps increasing, especially in very preterm infants (born before 33 weeks of gestation) who present the poorest outcomes and the highest mortality rates.[1,2,3]. Several authors have reported a potential association between maternal haemoglobin concentration and various neonatal outcomes in the whole neonatal population. Described associations usually follow a U-shaped distribution with adverse outcomes at both ends of the haemoglobin range. We decided to check if this association remained in very preterm neonates born before 33 weeks of gestation. We tested this hypothesis in a hospital based observational study with prospective data collection
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