Anemia Of Prematurity Research Articles

Evaluation of blood component transfusion in sick neonates- a retrospective study in a rural tertiary new-born care unit of Eastern India

Background: In recent past, blood transfusion in neonates has developed a lot improving the outcome particularly in premature and low birth weight babies. However, there are no globally followed standardised guidelines for neonatal blood transfusion. The present study conducted with the objective to evaluate the frequency, indications, complications and appropriateness of various blood components transfusion in sick newborn care unit (SNCU) of a resource poor setting.Methods: This retrospective, hospital based, single centre observational study is done in a tertiary care SNCU of a teaching hospital of eastern India. All SNCU admitted neonates who received blood/ blood component transfusion from October 2018 to September 2019 were evaluated for blood component usage and their indications and followed up throughout hospital stay. The data were statistically analysed using Microsoft Excel™ software.Results: In this study 219 neonates received a total of 359 bags of blood component transfusion. Out of these packed red blood cell (PRBC), fresh frozen plasma (FFP), random donor platelet and whole blood were 233 (64.90%), 97 (27.01%), 10 (2.78%) and 19 (5.29%) respectively. The major indications for transfusion were anaemia of prematurity (35.37%), sepsis (26.18%) and bleeding disorder (16.71%). The common transfusion-related complications observed in our study were cardiac abnormality (22.35%), electrolyte disturbance (6.40%) and hypoglycaemia (19.17%).Conclusions: Anaemia of prematurity was the foremost indication of transfusion. Multiple transfusions were associated with prematurity and low birth weight.

18 Prevalence of iron deficiency among extreme preterm neonates based on Reticulocyte-Hemoglobin levels: a single center cross-sectional study

Abstract Background Extreme preterm neonates are at risk of developing iron deficiency due to multiple factors including lack of third trimester placental iron accretion and frequent blood sampling. The true prevalence of iron deficiency in this cohort is not known due to lack of valid markers. Compared to Hemoglobin (Hb) derived from the entire red blood cell population (lifespan 120 days), Hb derived for reticulocytes (lifespan 3 days) is a real-time indicator of functional iron available for erythropoiesis during the previous 3-4 days. Reticulocyte-Hemoglobin (Ret-Hb) levels lower than 29pg can indicate iron deficiency in preterm neonates < 32 weeks gestation with 85% sensitivity and 73% specificity. Objectives This study aims to measure the prevalence and risk factors of iron deficiency at term equivalent age among extreme preterm neonates based on Ret-Hb levels. Design/Methods A single center retrospective chart review of neonates born at <= 29 weeks gestation between June 2016 to December 2019. All neonates received routine iron supplementation from 2 weeks postnatal age at 3-4mg/kg/day (birth weight <1Kg) or 2-3mg/kg/day (birth weight>1Kg) to a maximum of 15mg elemental iron as ferrous sulfate or iron fortified formula. Hb, Reticulocyte count, Ret-Hb, Immature reticulocyte fraction (IRF) and mean corpuscular volume (MCV) was measured at 4 weeks postnatal age, 36 weeks corrected gestation, and at discharge. Iron deficiency at term equivalent age was defined as Ret-Hb levels <= 29pg. Results Among 387 eligible neonates, 187 who had hematological parameters available at term equivalent age were included. The study cohort had a mean gestation of 25.7 (1.6) weeks, birth weight of 863 (220) g, mean SNAPPEII score of 29.2 (19), and gestational age at discharge of 42.7 (7.2) weeks. The prevalence of iron deficiency among neonates < 24 weeks, 24-25 + 6 weeks, 26-27 + 6 weeks, and >=28 weeks was 35.7%, 18.4%, 27.7%, and 15.6% respectively. Male infants were more likely to have iron deficiency at term equivalent [Table 1]. The neonates with iron deficiency had higher rates of necrotising enterocolitis [14% versus 8%], laparotomy [14% versus 10%] and postnatal steroids [69% versus 57%] compared to neonates without iron deficiency, however not statistically significant. Ret-Hb levels at 4 weeks postnatal age showed a positive correlation with Ret-Hb levels [Slope 0.58, R2 squared 0.02] and MCV levels [Slope 0.75, R2 0.11] at discharge [Figure 1]. Contrary to changes in Hb levels and reticulocyte counts, Ret-Hb levels, MCV and IFR progressively decrease from 4 wks postnatal age to discharge. Conclusion Despite routine standardized iron supplementation, extreme preterm neonates may have iron-limited erythropoiesis indicated by low Ret-Hb levels at term equivalent age. Lower levels of Ret-Hb at 4 weeks postnatal age was associated with low IRF and low MCV at discharge although Hb levels may remain within acceptable range. Future studies would need to elucidate the impact of iron deficiency at corrected term on long-term outcome. Guidelines should consider incorporating Ret-Hb levels in the workup of anemia of prematurity.

Effect of Small Volume Blood Sampling on the Outcomes of Very Low Birth Weight Preterm Infants.

Very low birth weight (VLBW) preterm infants universally experience anemia of prematurity (AOP) while growing up. The effects of reduced blood sample volume on AOP, packed red blood cell (PRBC) transfusion, and outcome in VLBW preterm infants were examined in this study. To reduce blood loss due to phlebotomy, we set up a small volume blood sampling procedure in VLBW infants. In this retrospective study, we compared the VLBW infants who had undergone standard blood sampling (control group, n = 20) with those who underwent small volume blood sampling (study group, n = 84), with both groups receiving PRBC transfusion under restrictive criteria. Blood loss from phlebotomy and PRBC transfusion volume over 30 days was significantly lower in the study group than in the control group. Compared to the control group, hematocrit, reticulocyte, and iron levels were significantly higher in the study group. There were no significant differences in the proportion of patent ductus arteriosus, severe intraventricular hemorrhage, retinopathy of prematurity, and bronchopulmonary dysplasia between the two groups. The small volume blood sampling resulted in lower PRBC transfusion volume, less severe anemia, and greater bone marrow function at 30 days of age. This strategy can reduce potential adverse effects of PRBC transfusion in VLBW preterm infants.

Recommendations for transfusion of blood products in neonatology

The scant evidence on the use of transfusions in neonatal care explains the limitations of current clinical guidelines. Despite this, in this document we explore the most recent evidence to make recommendations for the clinical practice. The prevention of anaemia of prematurity, the use of protocols and restrictive transfusion strategies constitute the best approach for clinicians in this field. In the case of platelet transfusions, the risk of bleeding must be assessed, combining clinical and laboratory features. Lastly, fresh frozen plasma is recommended in neonates with coagulopathy and active bleeding, with congenital factor deficiencies for which there is no specific treatment or with disseminated intravascular coagulation. All blood products have adverse effects that warrant a personalised and thorough assessment of the need for transfusion.

Recomendaciones para la transfusión de hemoderivados en neonatología

The scant evidence on the use of transfusions in neonatal care explains the limitations of current clinical guidelines. Despite this, in this document we explore the most recent evidence to make recommendations for the clinical practice. The prevention of anaemia of prematurity, the use of protocols and restrictive transfusion strategies constitute the best approach for clinicians in this field. In the case of platelet transfusions, the risk of bleeding must be assessed, combining clinical and laboratory features. Lastly, fresh frozen plasma is recommended in neonates with coagulopathy and active bleeding, with congenital factor deficiencies for which there is no specific treatment or with disseminated intravascular coagulation. All blood products have adverse effects that warrant a personalised and thorough assessment of the need for transfusion.

Changes in Platelet Function in Preterm Newborns with Prematurity Related Morbidities.

Platelet indices represent useful biomarkers to express the thromboembolic status, inflammatory response, and oxidative stress in preterm newborns. Our study presented platelet count and function changes in prematurity-related morbidities such as respiratory distress syndrome, intraventricular bleeding, and anemia of prematurity in preterm newborn cases reported to healthy full-term newborns by flow cytometry and hematological methods. The platelet volume represents the average size of platelets in the blood samples, showing the significantly increased values in preterm newborns compared with healthy full-term newborns due to increasing activated platelet production. Flow cytometric analysis of immature platelet fractions (IPF) made using thiazole orange staining to detect their mRNA content and a glycoprotein (anti-GPIIIa) antibody for platelet gating. CD61-TO expression from premature newborns was significantly lower compared to healthy full-term neonates. Preterm newborn cases with respiratory distress syndrome and a need for respiratory support (RDS+) were characterized by a significantly increased platelet volume and a decreased immature platelet fraction reported in RDS− cases. Evaluating the platelet function in the newborn is difficult because the laboratory methodologies work with small quantities of newborn blood samples. The immature platelet fractions and platelet volume promise to be diagnostic biomarkers for diseases.

A Culture of Too Many Blood Cultures.

A Culture of Too Many Blood Cultures.

Anemia of Prematurity Management in the Tertiary Neonatology Centre of Clinical Emergency County Hospital Constanta

Abstract Objective: Preterm neonates represent a category of neonates at high risk for anemia. Due to particular pathologic processes and clinical presentation in preterm neonates, this type of anemia is described as a separate entity named anemia of prematurity (AOP). The population represented by very low birthweight (VLBW) neonates is at the highest risk of developing anemia of prematurity. Reduced tissue oxygenation due to anemia can have short-term consequences (growth restriction, apnea episodes) or long-term consequences such as delayed neurological development, rapid detection, and management of AOP is needed to avoid its complications. Material and methods: We describe the particularities of this condition and the interventions for its prevention or correction in a group of premature infants born at less than 32 weeks of gestation discharged home during 2021. Results: We assessed the presence of anemia and the need for erythrocyte transfusion in 32 VLBW neonates, separated into two groups based on the gestational age: 24-29 gestational weeks (GW) and 30-31 GW. The number of neonates receiving a transfusion and the number of transfusion events was higher in the former, more immature group. We also identified more significant phlebotomy losses in the first group, contributing to a higher proportion of AOP cases needing erythrocyte transfusion. Conclusions: Although our protocols for transfusion at this moment recommend lower hemoglobin thresholds, we tend to transfuse above those levels based mainly on clinical signs and symptoms. We need better prevention strategies for AOP, both by using cord blood and more strict monitoring of phlebotomy losses.

Features of Anemia in Extremely Preterm Children in Neonatal Period

Background. The study of anemia causes in children born prematurely remains the urgent problem due to the continuous search for effective ways to prevent and treat it.Objective. The aim of the study is to study the anemia severity in premature infants, peripheral blood test results (MCV, MCH, MCHС), serum iron, and ferritin at different gestational periods.Materials and methods. 82 medical records of preterm infants were analyzed. 12 children were extremely premature (EР), 36 were very premature (VP), 27 were moderately premature (MP), and 7 were late premature (LP). The frequency of anemia, its severity, and laboratory indicators of iron metabolism were studied.Results. In EР infants, anemia developed in 100% (severe and moderate form in 16.7%, mild in 66.6%), in VP — in 94.6% (of which severe form in 5.6%, moderate — 22%, mild — 67%). Severe forms were not detected in children over 32 weeks of gestation. In infants with ЕР, the iron level at 2 weeks Me (median) 10.6 μmol/l [8.8–12.1], which is lower than in the comparison groups: VP — 15.9 [12.3–18.9] (p = 0.007), MP — 18,7 [15.8–20.5] (p = 0.0002), LP — 14,0 [16.2–23.8] (p = 0.011). Serum ferritin in the EР group is 58.4 μg/l [52.8–71.7], lower than the level in children with OH — 165.5 μg/l [77.3–195] (p = 0.03). The indicators MCV, MCH did not reflect the etiology of anemia, MCHC is reduced in all groups. With oral subsidization of 3-valent iron, its level increase in EР: before treatment — 10.65 μmol/l [8.2–12.1], after 2 weeks — 21.95 μmol/l [17.8–23,9] (p = 0.011).Conclusion. Severe and moderate degrees of early anemia of prematurity are diagnosed in the EР and VP groups. Significant deficiency of serum iron was detected in EР at the age of 2 weeks. MCHC less than 33.1% was registered in all gestational periods, it can be the marker of early anemia of prematurity. Iron supplement is required for EР.

Reticulocyte hemoglobin content changes after treatment of anemia of prematurity.

Iron deficiency during infancy is associated with poor neurological development, but iron overload causes severe complications. Appropriate iron supplementation is therefore vital. Reticulocyte hemoglobin content (RET-He) provides a real-time assessment of iron status and chracterezes hemoglobin synthesis in preterm infants. However, the existing literature lacks detailed reports assessing chronological changes in RET-He. The aim of this study was to assess the chronological changes in RET-He during oral iron dietary supplementation, and concomitant therapy with recombinant human erythropoietin (rHuEPO) in preterm very low birthweight infants. Very low birthweight infants, admitted to our neonatal intensive care unit were analyzed retrospectively. Hemoglobin (Hb), reticulocyte percentage (Ret), mean corpuscular volume, RET-He, serum iron (Fe), and serum ferritin were recorded. Data at birth (T0), the initial day of rHuEPO therapy (T1), the initial day of oral iron supplementation (T2), 1-2 weeks (T3), 3-4 weeks (T4), 5-6 weeks (T5), and 7-8 weeks (T6) from the initial day of oral iron supplementation were extracted, and their changes over time were examined. Reticulocyte hemoglobin content was highest at birth and declined rapidly thereafter, especially after starting rHuEPO therapy. There was no upward trend in RET-He after the initiation of oral iron supplementation, with a slower increase during 5-6 weeks after the initiation of iron therapy. During the treatment of anemia of prematurity, low RET-He levels may be prolonged. Anemia of prematurity should therefore be assessed and treated on a case-by-case basis, while considering the iron metabolic capacity of preterm infants.

Regional Oxygenation and Perfusion Monitoring to Optimize Neonatal Packed Red Blood Cell Transfusion Practices: A Systematic Review.

Contemporary packed red blood cell transfusion practices in anaemic preterm infants are primarily based on measurement of hemoglobin or haematocrit. In neonatal intensive care units, most preterm infants receive at least 1 packed red cell transfusion as standard treatment for anaemia of prematurity. Clinicians are faced with a common question "at what threshold should anaemic preterm infants receive packed red blood cell transfusion?". While evidence from interventional trials offers a range of haemoglobin levels to clinicians on thresholds to initiate red cell transfusion, it does not offer identification of exact haemoglobin level at which regional oxygenation and perfusion gets compromised. Assessment of regional oxygenation using near infrared spectroscopy and perfusion using ultrasound could offer a personalized transfusion medicine approach to optimize transfusion practices. We conducted a systematic review of the literature to identify the role of both regional oxygenation and/or ultrasound-based perfusion monitoring as a potential trigger to initiate packed red blood cell transfusion in anaemic preterm infants. MEDLINE, Embase, Maternity and Infant Care database were searched up to March 2021. Publications identified were screened and relevant data was extracted. Changes to regional oxygenation and/or perfusion monitoring before and after packed red blood cell transfusion were the primary outcomes. 44 out of 755 studies met the inclusion criteria and were included in the final analysis. Most were prospective, observational studies in stable preterm infants. Overall, studies reported an improvement in regional oxygenation and/or ultrasound-based perfusion after packed red blood cell transfusion. These changes were more consistently observed when hemoglobin <9.6g/dL or hematocrit was <0.30. Significant variation was found for patient characteristics, postnatal age at the time of monitoring, criteria for diagnosis of anaemia, and period of monitoring as well as regional oxygenation monitoring methodology. Regional oxygenation and/or perfusion monitoring can identify at-risk anaemic preterm infants and are promising tools to individualize packed red blood cell transfusion practices. However, there is lack of evidence for incorporating this monitoring, in their present form, into standard clinical practice. Additionally, consistency in reporting of study methodology should be improved.

Nutritional status analysis in preterm infants on different types of feeding

Breathing newborns born prematurely is a challenging task of modern perinatology. One of the main factors determining the normal growth and development of newborns (especially premature babies) is adequate nutrition. Assessment of nutritional adequacy includes anthropometry data in the dynamics, analysis of nutritional tolerance and, when indicated, a set of laboratory tests, of which the most important are clinical laboratory results (hemoglobin and traditional parameters of erythrocyte evaluation) and biochemical parameters characterizing protein metabolism (including indirect method of assessment of visceral protein reserves by urea level), iron supply, vitamin status, etc. Data on the nutritional status of premature infants in the period of newborn feeding are very scarce and controversial in the modern scientific literature, which determines the need for further studies on this problem.&#x0D; Aim. To study the parameters of nutritional status (hemoglobin, total protein, albumin, creatinine, urea, plasma glucose) at birth, in dynamics on 10, 20, 30 days of life in the preterm infants with very low (VLBW) and low body weight (LBW) at birth on different types of feeding (breast milk GM, GM in combination with fortificator and artificial nutrition AI) to assess measures of feeding success and quality of nursing.&#x0D; Materials and methods. The study of 118 infants aged from birth to 1 month of life in the Department of Pathology of Newborn and Premature Babies, Krasnoyarsk Regional Perinatal Center of Maternal and Child Health Protection. Group 1 consisted of 50 infants with OMT at birth, of whom 3 subgroups were formed depending on the type of feeding: breastfed (HB) 17 infants, "enriched" GM (HB + fortificator) 17 children, IV feeding - 16 children; Group 2 consisted of 68 children with OMT at birth, of whom 36 were on HB, 12 were on HB + fortificator, 20 were on IV.&#x0D; Results. Assessment of the nutritional status of neonates with NFMT during IM revealed specific features in the development of early anemia of prematurity (10% of cases), high values of total protein in children by the end of the observation period in combination with increasing urea at all stages of observation and a higher creatinine level on day 20 of life. The incidence of early anemia of prematurity was comparable between the subgroups on different types of feeding and lower levels of total protein, albumin, and urea in the subgroup of children receiving HF + fortificator were obtained in the group of neonates with NMT.

Exposure to high levels of oxygen in neonatal rats induce a decrease in hemoglobin levels.

Anemia of prematurity is common in extremely preterm neonates, and oxygen exposure may participate to anemia by inhibiting erythropoietin secretion. We aimed to determine whether hyperoxia exerts an independent role in the occurrence of the anemia of prematurity. Sprague-Dawley pups were exposed to 80% oxygen or room air from days 3 to 10 of life. Main outcome was the difference in hemoglobin and circulating erythropoietin levels in animals exposed to hyperoxia at 10 days of life. We performed a complete blood count analysis using fluorescent laser flow cytometry and measured circulating erythropoietin levels using ELISA. We found lower hemoglobin in the hyperoxia group, compared to the normoxia group, both in males (70 ± 3 versus 78 ± 2 g/l) and in females (71 ± 2 versus 81 ± 3 g/l) at 10 days of life. Reticulocyte count was not increased in the hyperoxia group. Circulating erythropoietin levels were lower at 10 days of life in the animals exposed to hyperoxia, both in males (33 ± 7 versus 73 ± 6 pg/ml) and in females (37 ± 5 versus 66 ± 3 pg/ml), but were similar at 28 days of life. Neonatal exposure to hyperoxia decreases hematopoiesis in rats. Mechanisms leading to anemia of prematurity are not well known and their study in humans is complicated due to multiple confounders. This study shows for the first time that exposure to high concentrations of oxygen in the neonatal period decreases hematopoiesis in rats, providing insight on the pathophysiological mechanisms of the anemia of prematurity. This research paves the way for future therapeutic developments aiming to reduce the burden of anemia of prematurity and the necessity of red blood cell transfusions in extremely preterm neonates.

Maternal and Neonatal risk factors in retinopathy of prematurity: A study from coastal city in south India

Preterm babies often suffer from various systemic illnesses and struggle for survival in the neonatal intensive care unit (NICU). These preterm babies are at risk of developing ROP which is a potentially blinding condition. The presence of predisposing maternal and neonatal factors contributes for the development of ROP. Determining the association of risk factors with the development of ROP is essential in improving the screening and management of ROP. To determine maternal, neonatal risk factors and influence of retinal immaturity at first screening for development of ROP. Prospective, observational study conducted at a level of 3 PICU &amp; department of ophthalmology. All the preterm infants with gestational age ≤ 37 weeks admitted in NICU were first screened by 2 to 3 weeks of chronological age and followed up till the completion of retinal vascularization and regression of ROP following treatment. The zone of retinal vascularization at first screening and various maternal and neonatal risk factors were noted. Out of 166 babies screened, 18.67% progressed to ROP. Of the 36 babies with immature retina 58% developed ROP, while 7.7% neonates with mature retina developed ROP. Gestational age, birth weight, retina immaturity, respiratory distress syndrome and anaemia of prematurity were statistically significant for ROP.Statistical analysis: Descriptive statistics was used to identify the association of risk factors with the development of ROP. Each risk factor was analyzed by univariate &amp; multivariate logistic regression. Low birth weight, low gestational age, immature retina and neonatal risk factors have a significant influence on the development of ROP. Low birth weight, low gestational age and retinal immaturity are important risk factors for Retinopathy of prematurity.

The effectiveness of umbilical cord milking/ delayed cord clamping and recombinant human erythropoietin in reducing red blood cell transfusions in extremely and very low birth weight infants

Anemia of prematurity is one of the most common and serious problems of neonatology. The main focus is to prevent of anemia in preterm infants. The aim of the study was to assess effectiveness of umbilical cord milking/delayed cord clamping and erythropoietin therapy in reducing red blood cell transfusions in extremely and very low birth weight infants. This clinical study was approved by the Commission on ethics of biomedical research (Protocol No. 12 November 17, 2016) and approved by the Scientific Council of National Medical Research Center for obstetrics, gynecology and perinatology named academician V.I. Kulakov of the ministry of Healthcare of the Russian Federation (Protocol No. 19 of November 29, 2016). Analysis of 482 extremely and very low birth weight infants was conducted (from 2008 to 2018). Umbilical cord milking or delayed umbilical cord clamping, both, and in combination with recombinant human erythropoietin therapy, decreasing the phlebotomy losses significantly reduces the need for transfusions of red blood cells in extremely and very low birth weight infants. The effectiveness of erythropoietin therapy, time of its start and various treatment schemes remain controversial, therefore further researches are necessary.

Features of the course of new coronavirus infection in newborns and first-year infants

The aim of the study was to assess the features of the course of new coronavirus infection in newborns and children of the first year of life. Materials and methods. Thirty-six children aged eight days to 11 months were hospitalized in the covid centre of the National Medical Research Center for Children’s Health (of which nine children were transferred from one of the surgical hospitals in Moscow due to the contact with SARS-CoV-2). Results. Despite severe concomitant surgical pathology in 25% of patients, 98% of children had mild to moderate disease. Febrile temperature (up to a maximum of 39 oC) was observed in 4 infants, sub-febrile temperature in 5 people. In other children, for the entire period of treatment, there was no increase in temperature. Mothers’ complaints about lethargy dominated the clinical picture of the disease, followed by refusal to eat, runny nose, sneezing, swallowing voice, coughing, shortness of breath in their children. During the examination, the following signs were revealed: yawn hyperemia, mucous separated from the nose, hard breathing and dry wheezing (in 1 infant). The general blood test showed anemia (mostly related to prematurity anemia, or iron deficiency anemia), leftward leukocytosis (due to concomitant surgical pathology), leukopenia, various changes in the leukocytic formula of blood. In some instances, thrombocytopenia increased in D-dimer C-RP, procalcitonin, ferritin, bilirubin, and alanine aminotransferase. In only six infants with a moderate disease course, changes characteristic of a new coronavirus infection were identified on the chest CT scan. Six infantas had rhythm disorders detected in electrocardiographic examination (no deviations were found in echocardiographic examination). Conclusion. According to both foreign literature and data obtained during our study, it can be concluded that, compared with adults, infants have a milder course of the disease and less pronounced changes obtained during laboratory and instrumental studies.

Pattern of Blood Transfusion in the Special Care Baby Unit of Benue State University Teaching Hospital in Makurdi North-Central Nigeria

Blood transfusion is a life-saving procedure in which whole blood or parts of blood are introduced into a patient's bloodstream intravenously. The need maybe due to physiological or pathological causes. The objective of this study was to document the pattern and indications for blood transfusion at the Special Care Baby Unit of the Benue State University Teaching Hospital (BSUTH), Makurdi. This study was a retrospective review of 126 neonates who received blood transfusion at the Special care baby unit of BSUTH from 1st January 2015 to 31st December 2019. Data was retrieved from patient's medical records and analyzed using IBM SPSS version 23. A total of 1142 neonates were admitted over the study period and 126 had blood transfusion giving a prevalence of 11.0%. Male/Female ratio of 1.57:1.Mean (±SD) Birth weight and gestational age (GA) were 2.23±0.82Kg and 35.48 ±3.95 weeks respectively. Exchange blood transfusion was the most frequent 53(42.1%) type of blood transfusion. The most common indications for blood transfusion were anaemia of prematurity, sepsis and severe neonatal jaundice. A hundred and twelve (88.9%) who received transfusion were discharged while 4(3.2%) died. The rate of blood transfusion was low, while severe neonatal jaundice and anaemia were the main indications for blood transfusion in this study. Exchange blood transfusion was the main type of transfusion.

A Clinical Study of Obstetrical and Perinatal Outcome In Teenage Pregnancies In Central Referral Hospital (CRH), Gangtok

Background: Teenage pregnancy can be defined as pregnancy that occurs after menarche up to the age of 19 years. It is one of the important causes of maternal as well as neonatal morbidity and mortality. There is an increased incidence of preterm deliveries in teenage girls with its associated complications in newborn such as increased incidence of hyaline membrane disease in newborn baby, anaemia of prematurity, neonatal hypoglycaemia, hyperbilirubinemia and need for neonatal intensive care unit admissions.&#x0D; Aims and Objectives: 1.To assess the quantum of problem of teenage pregnancy. 2. To ascertain the different risk factors associated with teenage pregnancy. 3. To evaluate outcome of pregnancy in teenage mothers. 4. Todetermine the extent and association of teenage pregnancy with poor obstetric outcome.&#x0D; Materials and Methods: It was a hospital based prospective case control study. All teenage pregnant patients who were admitted during the study period were included in the study and a representative group of equal number of non-teenage pregnant women who were admitted during the study period were included in the study. For statistical purposes p value less than 0.05 was taken as statistically significant.&#x0D; Results: The most common single complication in teenage pregnancies was found to be preterm deliveries which was seen in 15 (12%) patients followed by fetal distress (10.40%) Pre-Eclampsia (6.40%) and PROM (4.80%). Amongst non-teenage pregnancies the common complications seen were fetal distress (17.60%), PROM (8.80%). The incidence of PPH was found to be high in teenage pregnancies as compared to non-teenage pregnancies. The comparison of the neonates on the basis of incidence of low birth weight (LBW) showed that more LBW babies were born to teenage mother as compared to non-teenage pregnancies and the difference was found to be statistically significant (P&lt;0.05).&#x0D; Conclusion: Teenage pregnancy is associated with increased incidence of maternal as well as neonatal complications. In additions to maternal and neonatal complications it also has an immense impact on psychosocial consequences on teenage mothers.

Anemia, Hepcidin, and Vitamin D in Healthy Preterm Infants: A Pilot Study.

The etiology of anemia in premature neonates is multifactorial and may involve anemia of inflammation mediated by hepcidin. Hepcidin expression is suppressed by vitamin D. We aimed to investigate the interrelationship between hepcidin, anemia, and vitamin D status in preterm infants. Preterm infants aged 1 to 5 weeks were prospectively recruited at the neonatal intensive care unit of the Dana Dwek Children Hospital. Blood counts and serum levels of hepcidin, ferritin, iron, 25-hydroxyvitamin D [25(OH)D] and C-reactive protein (CRP) were measured and compared between anemic and nonanemic preterm infants. Forty-seven preterm infants (mean ± standard deviation gestational age at birth 32.8 ± 1.1 weeks, 66% males) were recruited. In total, 36% of the preterm infants were vitamin D deficient [25(OH)D < 20 ng/mL] and 15% were anemic. Hepcidin levels were significantly higher in anemic premature infants than in the nonanemic group (55.3 ± 23.9 ng/mL vs. 30.1 ± 16.3 ng/mL, respectively, p < 0.05). No differences were found in iron, ferritin, 25(OH)D, and CRP levels between anemic and nonanemic premature newborn infants. A positive correlation was found between hepcidin and ferritin (R 2 = 0.247, p = 0.02) and a negative correlation was found between 25(OH)D and CRP (R 2 = 0.1, p = 0.04). No significant correlations were found between 25(OH)D and hepcidin, iron, ferritin, or CRP. Anemia of prematurity was associated with high hepcidin serum levels. The exact mechanisms leading to anemia and the role of vitamin D warrant further investigation. · Hepcidin levels were significantly higher in anemic premature infants.. · A positive correlation was found between hepcidin and ferritin.. · Negative correlation was found between 25(OH)D and CRP..

Hemodynamics of different volumes of red blood cell transfusion in preterm infants.

Although many controversies exist regarding the risk of red blood cell (RBC) transfusions, half of preterm infants born at <32weeks of gestational age receive such transfusions because of anemia of prematurity. Because of the costs and risks associated with multiple transfusions, it has been suggested that a large transfusion volume reduces the number of transfusions. However, there have been persistent concerns that RBC transfusion might lead to volume overload. We examined the impacts of large (20mL/kg) compared to standard volume (15mL/kg) transfusions on the hemodynamic variables of stable, electively transfused, preterm infants, by serially measuring echocardiographic parameters and plasma B-type natriuretic peptide levels. A total of 39 infants born at <34weeks of gestation and aged >2weeks at the time of enrollment were randomly allocated to either a standard volume (15mL/kg) or a large volume (20mL/kg) group. Significant reductions in cardiac output and transient increases in plasma B-type natriuretic peptide levels were found after RBC transfusion in both the standard and large volume (20mL/kg) groups. However, these changes were not significantly different between the two groups. Large-volume transfusions could be tolerable in stable preterm infants with anemia.