Anemia Of Prematurity Research Articles

The Postnatal Growth Delay in Preterm Infants and Survey of the Risk Factors

The aim was to analyze the factors that are associated with growth delay (GD) and malnutrition in preterm infants during the first year of life. The trial included 150 preterm children. The data of life history and anthropometry were studied. The trial showed statistically significant correlation of GD in preterm babies with intrauterine growth restriction, prolonged respiratory care and tube feeding, formula feeding, anemia of prematurity, and severe asphyxia at birth. To optimize health care in preterm infants, it is necessary to consider the factors that correlate with GD and give the recommendations how to prevent or treat pathological and deficit conditions.

Guidelines on transfusion for fetuses, neonates and older children.

Guidelines on transfusion for fetuses, neonates and older children.

The effect of recombinant human erythropoietin in prevention of prematurity anemia induced by caffeine citrate

目的 观察应用重组人促红素预防枸橼酸咖啡因所致早产儿贫血的效果。 方法 选取90例早产儿分成三组，对照组给予常规治疗，观察组A给予枸橼酸咖啡因静脉滴注治疗，观察组B在治疗组A的基础上，生后第8天给予重组人促红素。三组患儿均在生后第8天开始给依地酸铁钠口服溶液，疗程共3周；对比三组早产儿治疗前后网织红细胞(Ret)、红细胞比容(Hct)、血红蛋白(Hb)、血清铁蛋白(SF)的变化情况，并统计其应用鼻塞连续气道正压通气的天数、呼吸暂停的天数及输血例数。 结果 经治疗后患儿Ret、Hct、Hb水平及输血例数、应用鼻塞连续气道正压通气的天数各组间差异均有统计学意义(P 0.05)。呼吸暂停的天数观察组A与观察组B间差异无统计学意义(P>0.05)，对照组多于另外两组，且有统计学意义(P<0.05)。 结论 重组人促红素能有效预防枸橼酸咖啡因所致的早产儿贫血。

Stratégies de transfusion placentaire pour le nouveau-né prématuré : clampage retardé et/ou traite du cordon ?

Anemia of prematurity remains a common complication despite recent advances in perinatal and neonatal medicine. The delayed cord clamping (at least 30seconds as recommended) has several benefits: increased hemoglobin and hematocrit levels at birth, improved initial hemodynamic, decreased incidence of transfusions and intraventricular hemorrhages. When the birth transition is difficult, wait 30seconds before clamping can be impossible. So as not to interfere with the neonatal resuscitation, the “milking” has been proposed as an alternative method to the delayed cord clamping. This is a safe and easy method, which can be done either by an obstetrician or pediatrician with comparable results for the child on his hemodynamic, hematological and neurological status. It still lacks technical information on this method and neurodevelopmental outcomes of these preterm infants.

MEDICATION MANAGEMENT OF THE EXTREMELY PREMATURE NEONATE – THE IMPACT OF A SPECIALIST PHARMACIST

AimTo present a case of an extremely premature infant and the role that the specialist neonatal pharmacist has on the quality of care of these patients.MethodInterventions and recommendations made by...

Early Erythropoietin Administration does not Increase the Risk of Retinopathy in Preterm Infants

Erythropoietin (EPO) administration prevents anemia of prematurity and may be associated with a significant increase in the risk of retinopathy of prematurity (ROP) in preterm infants. Nonetheless, early EPO treatment may prevent damage following retinal neovascularization. The aim of this meta-analysis was to elucidate whether EPO administration increases the risk of ROP. We searched MEDLINE, PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and the Cochrane Central Register of Controlled Trials with no language restrictions. Randomized controlled trials that reported the association between EPO treatment in preterm infants and ROP were eligible. All of the included studies were stratified into two groups according to the age of initiation of EPO treatment: before 8days of age (early EPO), and 8-28days of age (late EPO). Thirteen studies were identified that included a total of 1999 preterm infants. EPO administration did not increase the risk of ROP of any stage or Stage ≥3 (any relative risk: 0.99, 95% confidence interval: 0.84-1.16, p=0.89; Stage ≥3 relative risk: 1.34, 95% confidence interval: 0.90-1.99, p=0.15). This trend remained unchanged in both the early and late EPO groups. There did not seem to be any evidence of publication bias for outcomes as the funnel plots were symmetrical. EPO administration did not significantly increase the risk of ROP of any stage reported or Stage ≥3. Further clinical trials investigating the impact of EPO on ROP in premature infants should include all confounding factors to clarify this important issue.

SELECTION OF THERAPEUTIC TACTICS FOR EARLY ANEMIA OF PREMATURE INFANTS WITH VERY LOW OR EXTREMELY LOW BIRTH WEIGHT: RETROSPECTIVE STUDY RESULTS

Background: Early anemia of prematurity (EAP) is a serious issue of contemporary neonatology due to increasing survivability of premature infants. One of the most efficient preventive methods is extreme prematurity prevention. At the same time, efficacy of different methods of EAP therapy remains undetermined. Objective: Our aim was to compare efficacy of erythrocyte-containing donor blood components (packed red cells, erythrocytic suspension) and recombinant epoetin beta for treating premature infants with EAP. Methods: The retrospective cohort study provided analysis of data of premature infants (gestation age — 27–32 weeks) born with very low (VLBW) and extremely low birth weight (ELBW) and EAP (hemoglobin < 110 g/l, hematocrit < 27%, reticulocyte share < 20‰, normochromia, normocytosis; all criteria must have been met). We determined primary hematological morphological parameters and population structure of umbilical (at birth) and peripheral blood (after 30 days of treatment) leukocytes. Results: 32 premature infants with EAP underwent donor blood component transfusions, 26 — recombinant epoetin beta injections. The groups were comparable in terms of the primary clinical laboratory parameters. In the donor blood component group, we observed lower hemoglobin concentration (108 ± 17 vs. 119 ± 16 g/l in the epoetin beta group; p = 0.07) and reticulocyte share (3.7 ± 1.5 vs. 8.7 ± 1.7‰, respectively; p = 0,053) at the age of 1 month. We revealed a drop in cell immunity parameters in the setting of donor blood component transfusions: CD4+ lymphocyte share — down to 32,2 ± 14,0% (in the epoetin beta group; p = 0.055); CD8+ lymphocyte share — down to 21,2 ± 7,1% (in the epoetin beta group; p = 0.050). Conclusion: Epoetin beta is more efficient in terms of EAP correction in premature infants with VLBW and ELBW that erythrocyte-containing donor blood component transfusions. The latter are characterized by adverse effect on cell immunity parameters.

Treatment with erythropoietin in neonatology

The article presents the basics and con-trol of erythropoiesis in the fetus and the newborn, the development of anaemia of prematurity and its treatment, with an em-phasis on the use of human recombinant erythropoietin. The Intensive Care Unit of the Paediatric Clinic Maribor began treat-ing anaemia of prematurity with eryth-ropoietin in 2000. After introducing the treatment, the clinic found that the num-ber of blood product transfusions and the needed blood volume decreased. In addi-tion to erythropoietin, this was the result of stricter criteria for applying transfusion of concentrated erythrocytes.

“To Transfuse or Not to Transfuse”-A Neonatologist’s Daily Dilemma

Evidence based guidelines for the neonatal transfusions are still emerging. It is always a conundrum for a pediatrician, to decide when to give packed red blood cells to a growing premature infant with or without signs and symptoms of chronic neonatal anemia. It is further complicated, as some of that clinical picture can be explained by co-morbidities like neonatal sepsis, apnea of prematurity and caffeine therapy. So, that physician needs to weigh the risks and benefits for such seemingly benign procedure and also rule out conditions that can mimic the signs and symptoms of anemia of prematurity. Here, an attempt was made to provide suggestions for giving neonatal transfusion, using an algorithm approach. A review of recent literature was done and a short review was provided.

Iron Status in Early versus Delayed Cord Clamping Groups of Preterm Neonates Delivered in a Tertiary Level Hospital

Introduction: During pregnancy, most of the iron endowment occurs in third trimester; so preterm infant are deprived of iron which leads to anaemia of prematurity. The problems associated with anaemia in preterm babies as well as its treatment (blood transfusion) are multiple and involve significant risks. Anaemia hinders normal growth and contributes to postnatal malnutrition in most low birth weight preterm neonates who are hospitalised for a long time. Delayed cord clamping in preterm infants results in an 8% to 24% increase in blood volume.This extra amount of blood may increase haemoglobin as well as iron content in preterm neonates.Objective: To observe the effect of timing of cord clamping on iron status of preterm neonates.Methods: It is a prospective randomized control trial. Total 40 preterm neonates of gestational age of less than 37 weeks were included in this study, they were allocated in Early Cord Clamping (ECC) group and Delayed Cord Clamping (DCC) group by random sampling technique. To estimate iron status in both groups at neonatal period, blood was collected to measure Hb, MCV, TIBC, serum iron, ferritin at 24 hrs of age and at 28 days of age.Results: This study shows that there is significant high Hb, iron and ferritin levels in delayed cord clamping group of preterm neonates. The results of Hb, serum iron and ferritin levels at 24hrs of age in ECC group were 16.53(±2.13)g/dl, 52.20(±38.78)?g/dl and 127.63(±57.45)?g/L, these parameters in DCC group were 18.65(±2.08)g/dl, 84.35(±35.03)?g/l and 188.88(±107.58)?g/L respectively.These results were significant with the p value of &lt;0.05. These results were also significant at 28 days of life. But regarding Mean Corpuscular Volume (MCV) and Total Iron Binding Capacity (TIBC) parameters, they were not significant either in day 1 or in day 28.Conclusion: Delayed cord clamping improves iron status in preterm neonates status in early versus delayed cord clamping groups of preterm neonates delivered in certain referral hospital.Journal of Armed Forces Medical College Bangladesh Vol.10(2) 2014

Factors associated with red blood cell transfusions in very-low-birth-weight preterm infants in Brazilian neonatal units.

BackgroundPreterm infants in neonatal intensive care units frequently receive red blood cells (RBC) transfusions due to the anemia of prematurity. A number of variables related to gestational age, severity of illness and transfusion practices adopted in the neonatal unit where the neonate was born may contribute to the prescription of RBC transfusions. This study aimed to analyse the frequency and factors associated with RBC transfusions in very-low-birth-weight preterm infants.MethodsA prospective cohort of 4283 preterm infants (gestational age: 29.9 ± 2.9 weeks; birth weight: 1084 ± 275 g) carried out at 16 university hospitals in Brazil between January 2009 and December 2011 was analysed. Factors associated with RBC transfusions were evaluated using univariate and multiple logistic regression analysis.ResultsA total of 2208 (51.6 %) infants received RBC transfusions (variation per neonatal unit: 34.1 % to 66.4 %). RBC transfusions were significantly associated with gestational age (OR: -1.098; 95%CI: -1.12 to -1.04), SNAPPE II score (1.01; 1.00-1.02), apnea (1.69; 1.34-2.14), pulmonary hemorrhage (2.65; 1.74-4.031), need for oxygen at 28 days of life (1.56; 1.17-2.08), clinical sepsis (3.22; 2.55-4.05), necrotising enterocolitis (3.80; 2.26-6.41), grades III/IV intraventricular hemorrhage (1.64; 1.05-2.58), mechanical ventilation (2.27; 1.74-2.97), use of umbilical catheter (1.86; 1.35-2.57), parenteral nutrition (2.06; 1.27-3.33), >60 days of hospitalization (5.29; 4.02-6.95) and the neonatal unit where the neonate was born.ConclusionsThe frequency of RBC transfusions varied among neonatal intensive care units. Even after adjusting for adverse health conditions and therapeutic interventions, the neonatal unit continued to influence transfusion practices in very-low birth-weight infants.

Anaemia in the Premature Infant and Red Blood Cell Transfusion: New Approaches to an Age-Old Problem

Red blood cell (RBC) transfusion is a common intervention in very preterm infants with variable utilisation between centres and individual clinicians. This variation likely reflects uncertainty about who, when and how much to transfuse. Most RBC transfusions are given in small volumes as “top-up” for anaemia or cumulative phlebotomy loss. Whilst the newly born infant may have a low haemoglobin (Hb) value, it is uncertain if this is of clinical or physiologic significance except at extreme values. Little attention has been given to the potentially favourable effect of RBC transfusion on oxygen kinetics, particularly in the interval after birth when the risk of hypoxic ischaemia is high. Later anaemia, at the time of likely Hb nadir, more typifies anaemia of prematurity. In this article, we will firstly review the conventional model of RBC transfusion based on haemoglobin [Hb] thresholds and secondly, we will propose an alternate, individualised, practice based on the oxygen physiology. This effectively reframes the potential role of RBC transfusion in the very preterm infant and demands a new generation of clinical trials.

Recombinant human erythropoietin (rHuEPO) reduces transfusion requirements in anaemia of prematurity

Background: During the last two decades with the application of advanced technological supports have improved the survival rate of preterm very low birth weight (PT VLBW) infants. At the same time anemia of prematurity (AOP) one of the most frequent complications of these patients also has been increased in the neonatal units. Packed red blood cell (PRBC) transfusions are the mainstay of treatment of AOP. The frequency of blood transfusion is directly related to the exposure of the tiny preterm infants to various risks of transfusion.Objectives : To evaluate whether recombinant human erythropoietin (rHuEPO) therapy reduces the need of transfusions in AOP.Methods : A randomized controlled trial study was carried out at Neonatal Unit and Intensive Care Unit (ICU) of Dhaka Shishu (children) Hospital, Dhaka, Bangladesh with 60 PTVLBW neonates. Among them 30 in group I (rHuEPO group) and 30 in group II (control) were assigned. Therapy with rHuEPO (200 IU / kg / dose) thrice weekly was initiated on day 7 of life to group I for 2 weeks. From day 14 or after that as soon as enteral feeding was initiated oral iron and folic acid were received by both groups. Hematological assessment (haemoglobin, haematocrit level and reticulocyte count) were done at 6 and 10 weeks of life.Results : At the time of enrollment in the study PTLBW babies of both groups were almost similar in gestetional age, birth weight, hemoglobin, hematocrit values and reticulocyte count (p&gt;0.05). During the 10 weeks observation period, hematological values were increased and the number of blood transfusions as well as the number of infants who received any transfusion were reduced in rHuEPO group compared to control group (p&lt;0.01). No adverse effect of erythropoietin were found.Conclusion : The combination of rHuEPO and Iron, folic acid therapy significantly reduces the number of blood transfusion as well as the percentage of infants who received any transfusion in AOP.Northern International Medical College Journal Vol.6(2) 2015: 53-56

Analysis of characteristics of blood loss for laboratory test for 246 cases of critically ill premature infants

Objective To analyze the characteristics of blood loss for laboratory test of critically ill premature infants, and to seek feasible measures to reduce the blood loss. Methods Two hundred and forty-six cases of critically ill premature infants admitted to the neonatal intensive care unit from April 2012 to April 2013 were analyzed the blood loss for test during the hospitalization and the clinical features of blood loss with different gestational age, different weight within the first four weeks after admission.Then the application of blood loss according to test category was described.The blood volume demanded in theory was determined by the formula B=5(∑s+ 0.1), then calculated the phlebotomy overdraw on the basis of the practical blood loss and analyzed the characteristics of overdraw per patients per day in first two weeks after admission. Results Among 246 patients, The median blood loss figure was 25.57 ml for each infants with the range between 7.10 ml~119.20 ml, and the blood loss concentrated in first four weeks, which showed a decreasing trend with time.There was a statistically significant difference(P 0.05)between the third and fourth week.The largest proportion of the blood samples was used for clinical chemical tests(31.49%), followed by blood gas analysis(19.03%), immunoassays(12.69%), blood cultures(12.63%), hematology(12.28%). The practical blood loss was about twice times of blood volume demanded for tests in theory, which the median was 7.8 times to the latter(25.57 ml vs 3.26 ml). It showed statistically significant difference(P<0.05)between blood overdraw per patients per day in the first week and the second week.Compared with different gestational age and birth weight, the difference of overdraw was also statistically significant(P<0.05). According to test category, blood culture was the most significant samples of phlebotomy overdraw, followed by biochemical, other, blood gas analysis, the percentage was 76%, 64%, 45% and 41% respectively. Conclusion The blood loss for laboratory test and the phenomenon of blood waste is serious in critically ill preterm infants.The smaller the gestational age is, the lower the weight is, the amount of blood loss and phlebotomy overdraw are more significantly.Biochemical and blood gas analysis are the main items of blood loss. Key words: Preterm infants; Anemia of prematurity; Blood loss for test; Phlebotomy overdraw; Neonatal intensive care unit

Prevention of the anaemia of prematurity.

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.

Beneficial erythropoietic effects of recombinant human erythropoietin in very low-birth weight infants: A single-center randomized double-blinded placebo-controlled trial

Purpose: Due to appearing serious a complication following repeated blood products transfusion in premature neonates, beneficial protective effects of recombinant human erythropoietin (rhEpo) is being widely investigated. The present study evaluated the effectiveness of rhEpo in preventing anemia of prematurity by assessment of the changes in serum erythropoiesis parameters in very low birth weight (VLBW) neonates. Materials and Methods: In a single-center randomized, double-blinded, placebo-controlled trial, 60 premature infants with birth weight <1500g who were born between 24 and 31 weeks of gestation admitted to the neonatal intensive care unit of Fatemieh Hospital in Hamadan were enrolled. The study medication (rhEpo or placebo) was randomly assigned to each patient. The rhEpo (250 U rhEpo/kg body weight at birth, equal to 1 mL solution/kg birth weight) and placebo drug solutions were indistinguishable. The study drug was administered 3 times weekly for 3 weeks. Results: Monitoring hemoglobin, hematocrit and reticulocyte count showed no relevant deviation from baseline to the 2 nd week of the study. However, there was relevant difference for these parameters between investigated patients who received rhEpo and the patients who received placebo during the 3 rd week of the medication. 16 (53.3%) in the intervention group and 20 (66.7%) in the control group required blood transfusion with an insignificant difference. No serious side-effects were observed in either the rhEpo or placebo group. Conclusion: Our study suggested that rhEpo is an effective drug for improving erythropoiesis parameters after 3 weeks of administration in VLBW infants regardless its effect on the need for blood transfusions.

Tract-based spatial statistics to assess the neuroprotective effect of early erythropoietin on white matter development in preterm infants

Despite improved survival, many preterm infants undergo subsequent neurodevelopmental impairment. To date, no neuroprotective therapies have been implemented into clinical practice. Erythropoietin, a haematopoietic cytokine used for treatment of anaemia of prematurity, has been shown to have neuroprotective and neuroregenerative effects on the brain in many experimental studies. The aim of the study was to assess the effect of recombinant human erythropoietin on the microstructural development of the cerebral white matter using tract-based spatial statistics performed at term equivalent age. A randomized, double-blind placebo-controlled, prospective multicentre study applying recombinant human erythropoietin in the first 42 h after preterm birth entitled 'Does erythropoietin improve outcome in preterm infant' was conducted in Switzerland (NCT00413946). Preterm infants were given recombinant human erythropoietin (3000 IU) or an equivalent volume of placebo (NaCl 0.9%) intravenously before 3 h of age after birth, at 12-18 h and at 36-42 h after birth. High resolution diffusion tensor imaging was obtained at 3 T in 58 preterm infants with mean (standard deviation) gestational age at birth 29.75 (1.44) weeks, and at scanning at 41.1 (2.09) weeks. Imaging was performed at a single centre. Voxel-wise statistical analysis of the fractional anisotropy data was carried out using tract-based spatial statistics to test for differences in fractional anisotropy between infants treated with recombinant human erythropoietin and placebo using a general linear model, covarying for the gestational age at birth and the corrected gestational age at the time of the scan. Preterm infants treated with recombinant human erythropoietin demonstrated increased fractional anisotropy in the genu and splenium of the corpus callosum, the anterior and posterior limbs of the internal capsule, and the corticospinal tract bilaterally. Mean fractional anisotropy was significantly higher in preterm infants treated with recombinant human erythropoietin than in those treated with placebo (P < 0.001). We conclude that early recombinant human erythropoietin administration improves white matter development in preterm infants assessed by diffusion tensor imaging and tract-based spatial statistics.

Erythropoietin use in the newborn

The first descriptions of blood transfusion in neonates date back to the nineteenth century. Time is past but uncertainties still remain considerable on optimal red blood cell (RBC) transfusion use in an era of evidence-based medicine. The need for RBC transfusion in critically ill neonates is differently judged among clinicians due to a lack of an agreement on measures of the need for transfusion. However some studies have shown an association between preterm infant morbidities, such as necrotizing enterocolitis and significant intracranial hemorrhage, with transfusions. The erythropoietin (EPO) use might prove clinically important. Physiologically in all newborns there is a progressive fall in hemoglobin concentrations to the nadir at about 8–12 weeks of life. The nadir is even lower and sooner in preterm neonates. This anemia of prematurity is the consequence of multiple factors, some are physiological processes as vulnerability of red cells to oxidative damage, reduced red cell lifespan when compared to the adult, lower erythropoietin (EPO) response to anemia than in older ages, increased requirements due to the postnatal growth; some are non-physiological processes as iatrogenic blood sampling, inter-current illnesses and sepsis. All these factors are responsible for low plasma EPO concentration in preterm newborns. This provides a rationale for the use of EPO in prophylaxis or treatment of the anemia. EPO has been used clinically for more than 20 years and many randomized clinical trials demonstrated that EPO successfully stimulate erythropoiesis and decrease the need of transfusion in anemic adults and children with end-stage renal disease or cancer. Differently in preterm newborns, the EPO treatment has demonstrated varied success in decreasing the total number and volume of transfusions. There are not clear evidences from high quality trials to define the absolute requirement and benefit for neonatal RBC transfusion. A recent Cochrane metanalysis performed by Ohlsson A. and Aher S.M. (1) to assess the effectiveness and safety of early initiation of EPO or darbepoetin in reducing RBC transfusions in preterm and/or low birth weight infants, concludes that the small reductions in RBC transfusion observed after EPO treatment are of limited clinical importance. In contrast the possibly increased risk of ROP, does not recommend the administration of EPO. Darbepoetin requires further study for definitive conclusions.

Gestational Age-Specific Reference Ranges of Hepcidin in Cord Blood

Background: Iron deficiency (ID) contributes to anaemia of prematurity, and hence the reliable assessment of iron nutrition status appears to be mandatory. Objective: To establish gestational age (GA)-specific reference ranges for hepcidin concentrations in cord blood [Hep_(CB)] of preterm and term infants and to identify pre- and perinatal confounding factors. Methods: This is a prospective observational study including 221 infants (GA at birth: 24-42 weeks). Hep_(CB) along with complete blood counts, ferritin and parameters of inflammation and clinical data were recorded. Data are presented as medians (IQR). Results: The Hep_(CB) of very preterm infants (GA <30 weeks, n = 40) was 26.9 ng/ml (13.5-63.1), for moderately preterm infants (GA 30-36 weeks, n = 81) it was 45.9 ng/ml (24.7-74.5) and for term infants (GA ≥37 weeks, n = 100) it was 103.9 ng/ml (61.4-149.2). The Hep_(CB) of infants with ID was lower [36.9 ng/ml (18.0-58.3)] than that of iron-replete infants [86.6 ng/ml (51.9-143.8)]. The Hep_(CB) of infants delivered by elective caesarean section was lower [38.3 ng/ml (15.5-73.7)] than that of infants after spontaneous vaginal delivery or secondary caesarean section [80.3 ng/ml (48.5-137.6)]. Infants with a standard deviation score for birth weight (SDS_BW) <-2 had a lower Hep_(CB) [23.1 ng/ml (11.7-61.5)] compared to infants with SDS_BW ≥-2 [71.1 ng/ml (34.0-121.7)]. The highest Hep_(CB) (437.6 ng/ml) was recorded in an infant with Enterococcus faecalis sepsis. Multiple logistic regression analysis confirmed ferritin, GA and mode of delivery as important factors associated with Hep_(CB). Conclusion: This is the first report on GA-specific reference ranges for Hep_(CB) in preterm infants. Whereas iron stores, GA and mode of delivery were associated with Hep_(CB), the association with inflammation and intra-uterine growth retardation was less clear.

High dose EPO--friend or foe in the newborn?

High dose EPO--friend or foe in the newborn?