Neonatal Blood Transfusion Research Articles

Neonatal Blood Transfusion in Africa; Towards Optimizing Scarce Resource

Neonatal transfusion is a common practice in Africa, where many infants are born with low birth weight and require blood transfusions. The use of paediatric packs for neonatal blood transfusions has been recommended. However, the optimal use of these packs in Africa is not clearly understood by some healthcare practitioners. This review aims to provide insights into the optimal use of paediatric packs in neonatal transfusion in Africa.The World Health Organization (WHO) recommends restrictive transfusion practices for paediatric patients, including neonates, based on expert opinion. Transfusion triggers in neonates are controversial and mainly based on expert clinical opinion, although recent randomized controlled trials of ‘liberal’ versus ‘restrictive’ red cell transfusion policies in very low birth weight preterm babies are starting to influence clinical guidelines. Many neonatal red cell transfusions are given to replace losses from frequent blood sampling. This can be reduced by avoiding non-essential tests, using low-volume sample tubes, validated near patient testing, micro-techniques in the laboratory, and non-invasive monitoring where possible.The use of CMV-seronegative blood products for transfusion in low birth weight neonates is not deemed necessary. The primary rationale is that the risk of transfusion-transmitted infections should be reduced by stringent screening of donors, restrictive transfusion practice and certain interventions like irradiation of blood units before transfusion. A recent international survey of transfusion practices for extremely premature infants showed that factors considered “very important” regarding the need to administer blood transfusions included degree of oxygen requirement and need for respiratory support. Donor exposure can also be reduced by allocating single donor units, split into paedipacks, to babies predicted to need more than one transfusion episode within the expiry date of the donation. Implementing a program to improve compliance with neonatal intensive care unit transfusion guidelines was accompanied by a reduction in transfusion rate. The implementation of guidelines to improve compliance with neonatal intensive care unit transfusion guidelines can also reduce the transfusion rate.

Retrospective cohort study of neonatal blood transfusion in China

BackgroundBlood transfusion therapy is extremely important for certain neonatal diseases, but the threshold for neonatal blood transfusion is not the same in different countries. Until now, clinical studies to determine the suitable threshold for newborns in China are lacking. Therefore, it is of high importance to establish a multi-center cohort study to explore appropriate transfusion thresholds for newborns in China.MethodsThis retrospective cohort study investigated neonatal blood transfusion therapy administered from January 1, 2017 to June 30, 2018, with the aim of evaluating the effect of restricted and nonrestricted blood transfusion on neonatal health. The subjects were enrolled in 46 hospitals in China. A total of 5669 neonatal cases were included in the study. Clinical diagnosis and transfusion treatment of these neonates were collected and the data were retrospectively analyzed. The neonates were followed up 1 week and 1 month after leaving the hospital. The newborns’ and their mothers’ data were collected containing 280 variables in the database. The primary outcome of the study was mortality, and the secondary outcomes were complications, hospital stays, NICU hospital stays and hospital costs.ResultsResults from the < 1500 g group showed that there was a higher mortality rate in the restricted transfusion group (11.41%) when compared with the non-restricted transfusion group (5.12%) (P = 0.000). Among the secondary outcomes, the restricted transfusion group had fewer costs. Results from the 1500-2500 g group showed that the mortality rates of the restricted and non-restricted transfusion groups were 3.53% and 4.71%, respectively, however there was no statistical significance between the two groups (P = 0.345). Among the secondary outcomes, the restricted transfusion group had fewer hospital stays, NICU hospital stays and hospital costs. The incidence of necrotizing enterocolitis was lower in the restricted transfusion group (OR, 2.626; 95% confidence interval [CI], 1.445 to 4.773; P = 0.003). The results from the ≥ 2500 g restricted transfusion group suggested that the mortality rate of (3.02%) was significantly lower than that of non-restricted transfusion group (9.55%) (P = 0.000). Among the secondary outcomes, the restricted transfusion group had fewer hospital stays and hospital costs. The incidence of retinopathy of prematurity was lower in the restricted transfusion group (OR, 4.624; 95% confidence interval [CI], 2.32 to 9.216; P = 0.000).ConclusionsCurrent transfusion protocols for newborns weighing less than 1500 g may be inappropriate and lead to higher mortality. The current transfusion threshold performed better for the other two weight groups.

A Hidden Burden On Public Health: Adolescent Pregnancy And Increased Adverse Perinatal Outcomes

ABSTRACT&#x0D; Objective: Adolescent pregnancy, associated with increased adverse pregnancy outcomes, is a major public health problem. This study aimed to assess adverse perinatal outcomes in adolescent pregnancies by comparing them with adult pregnancies. &#x0D; Methods: 1104 adolescent and 2463 adult pregnant women were included. Presence of fetal anomaly, gestational diabetes, preeclampsia-eclampsia, intrauterine growth restriction, intrahepatic cholestasis, polyhydramnios, placenta previa, in utero mort fetus, uterine rupture, placenta abruption, umbilical cord prolapse, acute fetal distress, preterm birth, cesarean section, labor arrest, birth weight, macrosomia, dystocia, birth trauma, APGAR scores, neonatal intensive care unit admission, postpartum hemorrhage, hysterectomy, blood transfusion, and postpartum infection were recorded. &#x0D; Results: Rates of acute fetal distress, preterm birth, low birth weight, neonatal intensive care unit admission, postpartum hemorrhage, and blood transfusion were higher while birth weight, APGAR scores of fifth minutes, the rates of cesarean section, prolonged and arrested labor, gestational diabetes, and macrosomia were lower in adolescents. In regression analysis, being adolescent pregnant increase the risk of acute fetal distress by 1.4 times (aOR=1.439;95%CI=1.030-2.01, p=0.033), preterm birth by 1.7 times (aOR=1.692; 95%CI=1.104-2.596, p=0.016) and decrease the risk of gestational diabetes (aOR=0.182; 95%CI=0.116-0.286, p

Effect of delayed cord clamping on maternal and neonatal outcome in twin pregnancies: a retrospective cohort study

The objective of this study was to compare the maternal and neonatal outcomes following delayed cord clamping (DCC) versus immediate cord clamping (ICC) in twin pregnancies. This was a retrospective cohort study of 705 twin pregnancies who delivered at ≥ 24 weeks of gestation. Maternal and neonatal hemoglobin levels, blood transfusion, and neonatal outcomes were compared between DCC (n = 225) and ICC (n = 480) groups. Mean maternal predelivery and postpartum hemoglobin levels and the rate of postpartum hemoglobin drop ≥ 20% or maternal blood transfusion were comparable between the two groups. The DCC group had a significantly higher mean neonatal hemoglobin level (DCC vs. ICC: 17.4 ± 3.5 vs. 16.6 ± 2.7 g/dl, P = 0.010) but significantly lower rates of neonatal blood transfusion (DCC vs. ICC: 3.3% vs. 8.8%, P < 0.001) and respiratory distress syndrome (DCC vs. ICC: 6.7% vs. 15.2%, P < 0.001) than the ICC group. In conclusion, DCC compared with ICC in twin pregnancy was not associated with an increase of maternal postpartum bleeding complications, but it was associated with higher neonatal hemoglobin level and lower risks of neonatal blood transfusion and respiratory distress syndrome.

Spontaneous massive fetomaternal hemorrhage: two case reports and a literature review of placental pathology

BackgroundMassive fetomaternal hemorrhage (FMH) is a rare event during pregnancy that may cause severe fetal anemia or death.Case presentationThis paper reports two cases of fetomaternal hemorrhage with unexplained reasons. Both cases required emergency caesarean sections for non-reassuring fetal status and were treated with neonatal blood transfusion. Fetomaternal hemorrhage was confirmed via maternal Kleihauer-Betke test.ConclusionWe found parenchymal pallor, increased nucleated red blood cells (nRBCs), and syncytial knots (SKs) in the placentas, which are compatible with fetal anemia. Immunohistochemical staining indicated VEGF, CD34, and CD31 expression in the endothelial cells of the capillaries, characteristic of massive FMH placenta. This article also reviews the particular histopathological changes in FHM placenta according to the placental lesion classification system.

Analysis of Incidence of Adverse Events of Neonatal Blood Transfusion in Sharqia Governorate

Analysis of Incidence of Adverse Events of Neonatal Blood Transfusion in Sharqia Governorate

Comparison of perioperative outcomes and anesthetic-related complications of morbidly obese and super-obese parturients delivering by cesarean section

Objective To compare the perioperative outcomes and anesthetic-related complications of morbidly obese and super-obese parturients delivering by cesarean section. Methods A retrospective analysis of 6 years of data was performed. Exclusions were cases with gestational ages <24 weeks, placenta accreta spectrum, polyhydramnios, or multiple gestations. Results The study included 494 patients whose body mass index (BMI) exceeded 40 kg/m2 at delivery. Of these, 469 were morbidly obese (BMI 40–49.9; mean, 42.9 ± 2.4), and 25 were super obese (BMI >50; mean, 54.5 ± 4.2). Twenty-four (5.1%) morbidly obese women received general anesthesia. The other 445 patients (94.9%) in the morbid obesity group underwent cesarean delivery under regional anesthesia; however, some (2.2%; 10/445) received general anesthesia after regional anesthesia failed. In the super-obesity group, 23 patients (92.0%) received regional anesthesia, while two patients (8.0%) received general anesthesia. There were no cases of pulmonary aspiration, maternal deaths, or difficult or failed intubation. There was one episode of cardiac arrest in a patient with a BMI of 47.9. Among the morbidly obese and super-obese women given regional anesthesia, the super-obese patients had significantly greater volumes of ephedrine and norepinephrine consumption (p = 0.027 and 0.030), intravenous fluids (p = 0.006), and bleeding during surgery (p = 0.017). They also had more hypotensive episodes (p = 0.038). The two groups’ incidences of neonatal birth asphyxia, postpartum hemorrhage, blood transfusion, and uterine atony did not differ significantly. The lengths of stay in the hospital were also comparable. Conclusions Among the women receiving regional anesthesia, the super-obese parturients had greater intraoperative bleeding, a higher proportion of hypotensive episodes, and a greater vasopressor requirement than the morbidly obese parturients. Anesthesiologists must prepare for the adverse perioperative events that such women risk experiencing during a delivery by cesarean section. Trial registration www.clinicaltrials.gov ID: NCT04657692.

Targeted next-generation sequencing identifies eighteen novel mutations expanding the molecular and clinical spectrum of PKLR gene disorders in the Indian population.

Pyruvate kinase deficiency (PKD) is an autosomal recessive condition, caused due to homozygous or compound heterozygous mutation in the PKLR gene resulting in non-spherocytic hereditary hemolytic anemia. Clinical manifestations in PKD patients vary from moderate to severe lifelong hemolytic anemia either requiring neonatal exchange transfusion or blood transfusion support. Measuring PK enzyme activity is the gold standard approach for diagnosis but residual activity must be related to the increased reticulocyte count. The confirmatory diagnosis is provided by PKLR gene sequencing by conventional as well as targeted next-generation sequencing involving genes associated with enzymopathies, membranopathies, hemoglobinopathies, and bone marrow failure disorders. In this study, we report the mutational landscape of 45 unrelated PK deficiency cases from India. The genetic sequencing of PKLR revealed 40 variants comprising 34 Missense Mutations (MM), 2 Nonsense Mutations (NM), 1 Splice site, 1 Intronic, 1 Insertion, and 1 Large Base Deletion. The 17 novel variants identified in this study are A115E, R116P, A423G, K313I, E315G, E318K, L327P, M377L, A423E, R449G, H507Q, E538K, G563S, c.507 + 1 G > C, c.801_802 ins A (p.Asp268ArgfsTer48), IVS9dsA-T + 3, and one large base deletion. In combination with previous reports on PK deficiency, we suggest c.880G > A, c.943G > A, c.994G > A, c.1456C > T, c.1529G > A are the most frequently observed mutations in India. This study expands the phenotypic and molecular spectrum of PKLR gene disorders and also emphasizes the importance of combining both targeted next-generation sequencing with bioinformatics analysis and detailed clinical evaluation to elaborate a more accurate diagnosis and correct diagnosis for transfusion dependant hemolytic anemia in a cohort of the Indian population.

Neonatal Exchange Transfusion: When Should We Think about Hereditary Thrombotic Thrombocytopenic Purpura (hTTP)?

Introduction Neonatal exchange transfusion (NExT) is a procedure to treat severe neonatal hyperbilirubinemia persisting despite phototherapy, to remove red cell allo-antibodies associated with excessive neonatal hemolysis and to correct severe anemia. During the past decades, the number of NExT preformed have steadily decreased, particularly since the introduction of rhesus prophylaxis in rhesus negative women. Hereditary thrombotic thrombocytopenic purpura (hTTP) because of severe congenital ADAMTS13 deficiency is a rare, autosomal recessively inherited disorder with an estimated prevalence of one case per million. Although excessive neonatal hemolysis (often in conjunction with thrombocytopenia) seems to be prevalent in hTTP, patients are seldom diagnosed with hTTP in the neonatal period, possibly because hTTP is not recognized as a differential diagnosis of severe neonatal hyperbilirubinemia and NExT. In this study, we investigated the prevalence of severe neonatal hyperbilirubinemia necessitating NExT among confirmed hTTP patients enrolled in the International Hereditary TTP Registry (www.ttpregistry.net; ClinicalTrials.gov Identifier: NCT01257269), at participating sites and in the literature in the past 20 years. Methods The International Hereditary TTP Registry is a cohort study for patients with confirmed hTTP and their family members, established in 2006. The hTTP Registry collects clinical and treatment information, as well as laboratory parameters retrospectively up to enrollment (including performance of NExT), and then prospectively during annual follow-up visits. Participating study sites and/or national coordinating centers were asked to provide information on the number of and indication for all NExT performed between January 2001 and July 2022. Finally, we performed a literature search to identify reports on NExT / neonatal exchange blood transfusion over the same 20-year period. Results At present, the International Hereditary TTP Registry has enrolled 178 confirmed hTTP patients. Forty-two (24%) of them had required NExT because of severe hyperbilirubinemia in the neonatal period, which led to early diagnosis of hTTP in 7/42 (16%) cases. In the remaining 33 patients treated with NExT, hTTP diagnosis was established in infancy/early childhood (between 3 months - ≤6 years of age) in 20 patients, and in 15 instances after 6 years of age. Of the 136 hTTP patients not requiring NExT, 35 (26%) had a disease onset in the neonatal period although only four of them (11%) were diagnosed at this time, while the majority (20/35 patients, 57%) received their hTTP diagnosis following further acute episodes in late adolescence or adulthood. Twelve of the 20 sites or national coordination centers participating in the International Hereditary TTP Registry answered our survey and reported 70 neonates treated with NExT over a period of 20 years. Indication for NExT were severe hyperbilirubinemia and or severe anemia due to AB0 or Rhesus incompatibility. In none of the cases hTTP was suspected or diagnosed, as immune-hematological findings indicated severe allo-antibody mediated hemolysis. We retrieved from PubMed 887 publications mentioning NExT or neonatal exchange blood transfusion, of which we excluded 229 papers, that did not describe patients treated with exchange transfusions. In the remaining 658 publications, patients were treated with exchange transfusions because of severe hyperbilirubinemia due to AB0-, Rhesus- or minor blood group incompatibilities, glucose-6-phosphate deficiency, sickle cell disease and severe infections. Only three publications mentioned the indication TTP. Conclusions Despite increased awareness and tools to diagnose hTTP, prompt recognition and diagnosis remain a critical impediment and result in delayed diagnosis and treatment. Early and persistent severe hyperbilirubinemia (often in conjunction with thrombocytopenia) necessitating NExT prevalent in newborns later in life diagnosed with hTTP. Differential diagnosis of severe neonatal hyperbilirubinemia should include hTTP and we suggest to determine ADAMTS13 activity together with molecular analysis of the ADAMTS13 gene in case of an ADAMTS13 activity <10% in any newborn requiring NExT for severe hyperbilirubinemia.

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.

Association of Maternal and Neonatal Birth Outcomes With Subsequent Pediatric Transplants.

We identified maternal and neonatal birth characteristics that were associated with organ or tissue transplants during childhood. We designed a retrospective cohort study of the population of children born between 2006 and 2019 in Quebec, Canada. The exposure included birth complications such as congenital anomaly, neonatal blood transfusion, and oligohydramnios. The main outcome measure was organ or tissue transplantation before 14 y of age. We categorized transplants according to type (major organs versus superficial tissues). To determine the association of birth characteristics with risk of pediatric transplant, we estimated hazard ratios (HRs) and 95% confidence intervals (CIs) using Cox proportional hazards models adjusted for potential confounders. The cohort comprised 1 038 375 children with 7 712 678 person-years of follow-up, including 436 children who had transplants before 14 y of age. Birth complications were predominantly associated with major organ transplants. Congenital anomaly was associated with heart or lung (HR, 10.41; 95% CI, 5.33-20.33) and kidney transplants (HR, 13.69; 95% CI, 7.48-25.06), compared with no anomaly. Neonatal blood transfusion was associated with all major organ transplants, compared with no transfusion. Maternal complications were not as strongly associated with the risk of childhood transplant, although oligohydramnios was associated with 16.84 times (95% CI, 8.09-35.02) the risk of kidney transplant, compared with no oligohydramnios. Adverse birth outcomes such as congenital anomaly, neonatal blood transfusion, and maternal oligohydramnios are associated with a greater risk of transplantation before 14 y of age. Maternal and neonatal birth outcomes may be useful predictors of transplantation.

A Survey on Current Practices of Umbilical Cord Clamping in Malaysia.

BackgroundDelayed cord clamping (DCC) has been demonstrated to have significant benefits in reducing the incidence of intraventricular hemorrhage, blood transfusion and neonatal mortality in preterm neonates and improving hemodynamic and long-term neurodevelopment among term infants. There is no clear guideline on umbilical cord clamping (UCC) practices in Malaysia.ObjectiveThe aim of this survey was to assess the knowledge and practice of DCC among obstetric doctors and midwives in Malaysia, and pediatric colleagues who witness the delivery.MethodThis is a cross-sectional survey conducted in childbirth facilities in Malaysia from October 2020 to January 2021. A convenient snowball sampling was adopted. A validated questionnaire was disseminated to practicing obstetric and pediatric doctors and midwives electronically via email and WhatsApp using Google Form. The data were analyzed using descriptive and analytical statistics.ResultsA total of 327 respondents completed the questionnaires, comprising 206 obstetric doctors, 72 pediatric doctors and 49 midwives. The majority of respondents were specialists or higher in rank (53.2%). Only 29% reported the existence of guidelines on UCC in their place of work. Midwives (P = 0.003) and staff of lower ranks and level of education (P < 0.001) appeared to be more aware of the existence of a UCC guideline. Most respondents had positive knowledge of DCC for both term and preterm neonates. A large proportion (82%) of respondents agreed that DCC helped increase neonatal iron stores, and was good for both preterm (70.7%) and term (76.2%) neonates not requiring positive pressure ventilation. Doctors, specialists, those who are 40 years old and above, and those who have been in service for at least 10 years were found to have better knowledge regarding DCC (P < 0.05).ConclusionThe awareness and practice of obstetric, pediatric and midwifery staff of guidelines on UCC were less than satisfactory. Even though most respondents have good knowledge and positive perception regarding benefits of DCC, these were not translated into their routine practice. Hence, a national guideline emphasizing the benefits of DCC should be made available in all childbirth facilities.

Patterns and Determinants of Blood and Blood Products Transfusion in Neonate: An Experience of Single Institute

BACKGROUND: Neonates requiring intensive care are among the most frequently transfused group of patients. Indications for blood transfusion in neonates could be physiological or pathological. However, despite frequent blood transfusions in neonates in Iraq, there is a paucity of studies on its indications and patterns among neonates in our setting. AIM: The aim of the study is to shed light on the details of giving blood and blood products in the unit of neonate in Children Welfare Teaching hospital, Baghdad and the justifications for giving and its complication. PATIENTS AND METHODS: A descriptive study (cross-section study) includes all neonates admitted to neonatal care unit in Children Welfare Teaching Hospital. The study includes a group of newborns who were blood transfused during their admission to hospital, over a period of 6 months from October 1, 2019 to March 30, 2020. All data were collected from each patient and recorded in predesigned forma, these data include patient’s clinical data and analyzed using descriptive statistics. RESULTS: A total number of cases admitted over a period of 6 months were 862. One hundred and forty neonates received blood and its products transfusion, (61.4%) were male and (38.6%) were female, (62.9%) received packed red blood cells (PRBCs) followed by (18.6%) received exchange transfusion, (11.4%) received Fresh frozen plasma and (7.1%) received platelets. Most neonates received blood products transfused at (3–4) weeks. Post-natal age and were term babies (37–41) weeks. Gestational age mostly received PRBCs. CONCLUSIONS: Most neonates with a high rate of blood and blood product transfusion were males, term, need assistant ventilation, and transfused at 3–4 weeks postnatal age.

To study the effectiveness of umbilical cord blood transfusion in neonates at tertiary health care centre

To study the effectiveness of umbilical cord blood transfusion in neonates at tertiary health care centre

931 Maternal and neonatal outcomes associated with vasa previa resolution during the antepartum period

In recent years, the phenomenon of “resolved” vasa previa has been increasingly described when vasa previa (VP) is detected on ultrasound in the midtrimester with a resolution rate as high as 20-26%. There is little information on the obstetrical outcomes associated with resolved VP. Our objective was to describe obstetrical and neonatal outcomes in women with resolved VP and compare them to women who have persistent VP. This was a multi-center descriptive and retrospective cohort study of patients diagnosed prenatally with VP on transvaginal ultrasound in the NYC MFM Research Consortium centers between 2012 and 2018. The primary outcome was gestational age (GA) at delivery. Other outcomes evaluated included mode of delivery, birthweight, NICU admission, and preterm birth. Data were analyzed using Mann-Whitney U test and Fisher exact test with p<0.05 defined as significance. 165 pregnancies with VP were included, of which 16 were twin gestations. 43 VP cases (26.1%) including one twin gestation were noted to resolve on subsequent ultrasound, of which 6 were lost to follow up. Pregnancies with resolved VP had a higher median GA at delivery, lower rate of preterm birth <37 weeks, and lower rate of cesarean delivery. There was no difference in rate of preterm birth <32 weeks (Table 1). Neonatal data was available on 131 newborns. In cases of resolved VP, neonates had a higher median birthweight and lower rate of NICU admission. There were no significant differences in rates of neonatal blood transfusion or neonatal death (Table 2). Resolved VP is associated with later GA at delivery, lower rate of cesarean delivery, and improved neonatal outcomes. However, it is not associated with a reduction in preterm birth prior to 32 weeks. The observed preterm birth rate in the resolved group of 16% raises concern that resolved VP may be a risk factor for preterm birth and merits further investigation. Once VP is diagnosed, surveillance for VP resolution should be performed as resolution has important implications for obstetrical and neonatal outcomes.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Pattern of serum bilirubin changes following double volume exchange blood transfusion in neonates at a tertiary health facility in Nigeria.

Introductionexchange blood transfusion (EBT) is a form of massive transfusion useful in rapidly reducing serum bilirubin levels, but serum bilirubin levels frequently rebound within hours of completing the procedure, due to equilibration of extravascular bilirubin as well as on-going hemolysis. The study was carried out to determine the pattern of reduction in serum bilirubin levels following EBT among neonates with severe hyperbilirubinemia, as well as the factors contributing to this pattern, so as to establish evidence-based expectations following EBT.Methodsa retrospective descriptive study covering a two-year period in a Nigerian tertiary hospital. Details of the EBT procedures, including serial serum bilirubin levels, were obtained from the hospital records of all newborn babies who had double volume EBT done for severe hyperbilirubinaemia during the study period. Data was analyzed using the statistical software SPSS version 21.0.Resultsthe mean total serum bilirubin (TSB) before EBT in the 36 babies was 17.9 ± 6.3 mg/dl. The mean percentage decrease in TSB immediately following EBT was 44.3 ± 10.2%. Six hours after EBT, TSB levels had increased from the immediate post-EBT values by an average of 57.5 ± 32.2%. Twenty-four hours after the procedure, TSB values in most (87.1%) cases were still higher than the immediate post-EBT values, but lower than the pre-EBT values. Post-EBT anemia was recorded among 33.3% of the babies.ConclusionEBT is effective in rapidly reducing serum bilirubin levels and preventing acute bilirubin encephalopathy in neonates with severe hyperbilirubinemia, despite the rebound increase that occurs in TSB values after the procedure.

Influence of evening/night-time birth on maternal/perinatal outcomes in a low-risk population

Objective:To compare maternal and perinatal outcomes between day-time and evening/night-time births in a low-risk population.Material and Methods:The present study had a retrospective and cross-sectional design. The study recruited 421 pregnant women admitted for spontaneous or induced labor, with singleton, full-term pregnancy, without comorbidities, and with birthweight between 2,500 and 4,499 g. Maternal data, including severe bleeding, need for blood transfusion, puerperal infection, and admission to the intensive care unit, and neonatal data including birthweight, Apgar scores at first and fifth minute, oxygen administration, resuscitation, admission to the neonatal care unit, infection, and blood transfusion, were evaluated. Univariate and multivariate analysis and calculation of the prevalence ratio (PR) were performed with a 95% confidence interval (CI).Results:There were no differences in factors of maternal morbidity between delivery times. Newborns delivered during the evening/night-time had a higher prevalence of infection (15.3% vs 7.9%, p=0.019, PR: 2.11, CI 95% 1.13-3.93) and hospitalization in the neonatal care unit (25.8% vs 10.4%, p<0.001, PR: 2.99, CI 95% 1.76-5.10). There was no difference in other perinatal morbidities examined.Conclusion:Evening/night-time births were associated with a higher prevalence of infection and the need for admission to an intensive care unit.

The effect of concomitant histologic chorioamnionitis in pregnancies complicated by fetal growth restriction

IntroductionWe aimed to investigate the effect of placental histologic chorioamnionitis (HC) on neonatal outcomes in pregnancies complicated by fetal growth restriction (FGR). Methods- The computerized medical files of all pregnancies diagnosed with FGR (birthweight <10th percentile) at 24–42 weeks of gestation between 2008 and 2019 were reviewed. Maternal and neonatal outcomes were compared between FGR with and without evidence of placental HC.Placental lesions were classified according to “Amsterdam” criteria. Composite adverse neonatal outcome-included any of the following complications: neurological morbidity, neonatal respiratory assistance, RDS, NEC, sepsis, blood transfusion, phototherapy, hypoglycemia, or neonatal death. Composite severe adverse neonatal outcome included any of the following complications – neurological morbidity, blood transfusion, NEC, sepsis, RDS, neonatal death. Results- Compared to FGR without HC (n = 446), FGR with HC (n = 57) was characterized by more advanced gestational age at delivery 39.2 (38.3–39.9) vs. 38.2 (36.9–39.2), weeks respectively, p < 0.001), higher rate of nulliparity (73.7% vs. 45.1%, p < 0.001), less vascular lesions of MVM (1.8% vs.11.2%, p = 0.02), higher rate of Apgar scores at 5 min <7 (10.5% vs. 2%, p = 0.004), increased neonatal death (7.0% vs. 0.9%, p = 0.007), higher rates of both composite adverse neonatal outcome (31.1% vs. 17.3% p = 0.02), and composite severe adverse neonatal outcome (16.3% vs. 8.2% p = 0.04).By multivariate regression analysis HC was found to be independently associated with composite adverse neonatal outcome (aOR = 1.21, 95% CI 1.08–2.38) and with severe composite adverse neonatal outcome (aOR = 1.39, 95% CI 1.16–3.76). ConclusionsPregnancies complicated by FGR with concomitant HC were associated with higher rates of adverse neonatal outcomes.

Exchange blood transfusion in neonates with severe hyperbilirubinemia in a lower-middle-income country: can we minimise the incidence?

Our descriptive study examines the clinical profile of referred neonates who underwent exchange blood transfusion (EBT) and identifies possible interventions at peripheral hospitals to decrease their severe hyperbilirubinemia. Among the 38 neonates enrolled, the following were identified as potential clinical gaps in management: early discharge within 24 h of birth (57%); non-availability of ABORh blood grouping (43%); lack of anti-D immunoprophylaxis (75%); pathological weight loss because of inadequate breastfeeding (42%); and low usage of phototherapy. Because of late recognition, the mean age at admission was 5.4 ± 3.3 days, levels of total serum bilirubin (TSB) were 516.4 ± 123.1 µmol/L, and acute bilirubin encephalopathy (ABE) was seen in 45% of neonates. Rh iso-immunisation (39.5%), ABO iso-immunisation (21%) and sepsis (8%) were major risk factors for severe hyperbilirubinaemia. Quality prenatal screening identifying at-risk newborns, preventing early discharge after birth, a bilirubin nomogram risk assignment before discharge and assuring early recognition of hyperbiliubinaemia by parents may well minimise the incidence of EBT.

Blood Component Transfusion in Tertiary Care Neonatal Intensive Care Unit and Neonatal Intermediate Care Unit: An Audit.

BackgroundNeonates admitted in a tertiary neonatal intensive care unit (NICU) require multiple blood transfusions because of extended NICU stay and repeated sampling. The rookie organ systems and miniature blood volumes in the neonate call for regular audits in neonatal blood transfusion practice. Sharing component usage data with the blood bank will prepare them to store components according to demand, thus limiting wastage of components as well as make banks ready to face a shortage in case of ramped up requirements.ObjectiveAuditing neonatal blood transfusion indications and identifying the most commonly used component.MethodologyThis retrospective cohort study was conducted by the department of pediatrics over 22 months from February 20, 2017, to December 30, 2018. Any preterm and term neonates admitted to the NICU and Neonatal Intermediate Care Unit (NIMC) and receiving any transfusion, i.e., fresh frozen plasma (FFP), red cell concentrate (RCC), platelets, and exchange transfusion were included in our study. We collected data from the medical records of NICU and NIMC admitted patients receiving blood component transfusions from 2011 to 2016. Patients were categorized according to the classification of neonatal conditions by the International Classification of Diseases 11th Revision (ICD-11). There were no exclusion criteria. A descriptive statistical analysis was done, and a Chi-square test was applied.ResultsOut of 340 neonates, 249 (73.2%) were low birth weight, 139 (40.9%) were small for gestational age (SGA), and 277 (81.5%) neonates required transfusion during the first week of life. The majority of neonates require multiple transfusions. Fourteen(4.12%) neonates required up to 10 transfusions, two neonates required up to 22 transfusions, and 58 neonates required more than five blood transfusions. The majority required transfusion due to neonatal sepsis, Disseminated intravascular coagulopathy, low birth weight, respiratory distress syndrome, and unconjugated hyperbilirubinemia. Thirty-seven point eighty-two percent (37.82%) transfusions were fresh frozen plasma, 31.34% transfusions were red cell concentrate, 28.14% transfusions were platelet concentrate, and 2.70% were whole blood. Out of 340 neonates, 317 survived and were discharged.ConclusionThe most commonly transfused component was fresh frozen plasma, the indication was neonatal sepsis, and the group was preterm. Whole blood is still being used and needs to be stopped.