Abstract/References

Risk factors for anemia of prematurity among 30-35-week preterm infants

Hiroki Kitaoka, Yoshihiko Shitara, Kohei Kashima, Shingo Ochiai, Hayato Chikai, Keiko Watanabe, Hiroto Ida, Tadayuki Kumagai, Naoto Takahashi

Author information
  • Hiroki Kitaoka
    Department of Pediatrics, Yaizu City Hospital
    Department of Pediatrics, The University of Tokyo Hospital
  • Yoshihiko Shitara
    Department of Pediatrics, The University of Tokyo Hospital
  • Kohei Kashima
    Department of Pediatrics, The University of Tokyo Hospital
  • Shingo Ochiai
    Department of Pediatrics, Yaizu City Hospital
  • Hayato Chikai
    Department of Pediatrics, Yaizu City Hospital
    Department of Neonatology, Tokyo Metropolitan Bokutoh Hospital
  • Keiko Watanabe
    Department of Pediatrics, Yaizu City Hospital
  • Hiroto Ida
    Department of Pediatrics, Yaizu City Hospital
  • Tadayuki Kumagai
    Department of Pediatrics, Yaizu City Hospital
  • Naoto Takahashi
    Department of Pediatrics, The University of Tokyo Hospital

Abstract

Background: The risk factors for anemia of prematurity (AOP) among late preterm infants are unelucidated. We identified risk factors for declining hemoglobin (Hb) concentration and triggering factors for AOP treatment in infants born at 30-35 gestational weeks.

Methods: From 2012 to 2020, we conducted a single-center retrospective study of infants born at 30-35 weeks of gestation without congenital anomalies or severe hemorrhage. The primary outcome was AOP development, defined by initiation of treatments including red blood cell transfusion, subcutaneous injections of erythropoietin, and iron supplementation. A multivariable logistic regression model was used to investigate potential risk factors for AOP.

Results: A total of 358 infants were included. Lower gestational age (odds ratio, 0.19; 95% confidence interval 0.11-0.32), small for gestational age (SGA; 7.17, 2.15-23.9), low maternal Hb level before birth (0.66, 0.49-0.87), low Hb at birth (0.71, 0.57-0.89), and multiple large blood samplings (1.79; 1.40-2.29) showed significantly higher odds for AOP development.

Conclusions: Gestational age, SGA, low maternal Hb before birth, Hb at birth, and high number of large blood samplings were positively associated with AOP development in infants born at 30-35 gestational weeks.

The content of research paper

References

  1. Saito-Benz M, Flanagan P, Berry MJ. Management of anaemia in pre-term infants. Br J Haematol, 188:354-366, 2020.
  2. Alan S, Arsan S. Prevention of the anaemia of prematurity. Int J Pediatr Adolesc Med, 2:99-106, 2015.
  3. Strauss RG. Anaemia of prematurity: Pathophysiology and treatment. Blood Rev, 24:221-225, 2010.
  4. Aher SM, Ohlsson A. Early versus late erythropoietin for preventing red blood cell transfusion in preterm and/or low birth weight infants. Cochrane Database Syst Rev, 2:CD004865, 2020.
  5. Ohlsson A, Aher SM. Early erythropoiesis-stimulating agents in preterm or low birth weight infants. Cochrane Database Syst Rev, 2:CD004863, 2020.
  6. Aher SM, Ohlsson A. Late erythropoiesis-stimulating agents to prevent red blood cell transfusion in preterm or low birth weight infants. Cochrane Database Syst Rev, 1:CD004868, 2020.
  7. Balasubramanian H, Atyalgade M, Garg B, Srinivasan L, Kabra NS, Khapekar S. Effects of blood sampling stewardship and erythropoietin administration in extremely low birth weight infants-a quality improvement non-controlled before-and-after retrospective study. Eur J Pediatr, 180:1617-1626, 2021.
  8. Fischer HS, Reibel NJ, Bührer C, Dame C. Prophylactic early erythropoietin for neuroprotection in preterm infants:A meta-analysis. Pediatrics, 139:e20164317, 2017.
  9. Proytcheva MA. Issues in neonatal cellular analysis. Am J Clin Pathol, 131:560-573, 2009.
  10. Shohat M. Preterm blood counts vary with sampling site. Arch Dis Child, 62:74-75, 1987.
  11. Kayiran SM, Ozbek N, Turan M, Gürakan B. Significant differences between capillary and venous complete blood counts in the neonatal period. Clin Lab Haematol, 25:9-16, 2003.
  12. Yasuhi I, Yamashita H, Maeda K, Nomiyama M, Mizunoe T, Tada K, et al. High-intensity breastfeeding improves insulin sensitivity during early post-partum period in obese women with gestational diabetes. Diabetes Metab Res Rev, 35:e3127, 2019.
  13. Itabashi K, Fujimura M, Kusuda S, Tamura M, Hayashi T, Takahashi T, et al. Committee of Neonatal Medicine of Japan Pediatric Society. Introduction of new gestational age-specific standards for birth size. J Jpn Pediatr Soc, 114:1271-1293, 2010. [In Japanese]
  14. Venkatesh V, Khan R, Curley A, New H, Stanworth S. How we decide when a neonate needs a transfusion. Br J Haematol, 160:421-433, 2013.
  15. Ochiai M, Matsushita Y, Inoue H, Kusuda T, Kang D, Ichihara K, et al. Blood reference intervals for preterm low-birth-weight infants:A multicenter cohort study in Japan. PLoS One, 11:e0161439, 2016.
  16. Colombatti R, Sainati L, Trevisanuto D. Anemia and transfusion in the neonate. Semin Fetal Neonatal Med, 21:2-9, 2016.
  17. Davidkova S, Prestidge TD, Reed PW, Kara T, Wong W, Prestidge C. Comparison of reticulocyte hemoglobin equivalent with traditional markers of iron and erythropoiesis in pediatric dialysis. Pediatr Nephrol, 31:819-826, 2016.
  18. Piva E, Brugnara C, Spolaore F, Plebani M. Clinical Utility of Reticulocyte Parameters. Clin Lab Med, 35:133-163, 2015.
  19. Lorenz L, Peter A, Arand J, Springer F, Poets CF, Franz AR. Reticulocyte Haemoglobin Content Declines More Markedly in Preterm than in Term Infants in the First Days after Birth. Neonatology, 112:246-250, 2017.
  20. Lorenz L, Arand J, Büchner K, Wacker-Gussmann A, Peter A, Poets CF, et al. Reticulocyte haemoglobin content as a marker of iron deficiency. Arch Dis Child Fetal Neonatal Ed, 100:F198-202, 2015.
  21. Von Kohorn I, Ehrenkranz RA. Anemia in the Preterm Infant:Erythropoietin Versus Erythrocyte Transfusion-It’s not that Simple. Clin Perinatol 36:111-123, 2009.
  22. Badfar G, Shohani M, Soleymani A, Azami M. Maternal anemia during pregnancy and small for gestational age:a systematic review and meta-analysis. J Matern Neonatal Med, 32:1728-1734, 2019.
  23. Widness JA, Madan A, Grindeanu LA, Zimmerman MB, Wong DK, Stevenson DK. Reduction in red blood cell transfusions among preterm infants:Results of a randomized trial with an in-line blood gas and chemistry monitor. Pediatrics, 115:1299-1306, 2005.
  24. Rabe H, Gyte GM, Díaz-Rossello JL, Duley L. Effect of timing of umbilical cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes. Cochrane Database Syst Rev, 9:CD003248, 2019.
  25. Katheria A, Reister F, Essers J, Mendler M, Hummler H, Subramaniam A, et al. Association of umbilical cord milking vs delayed umbilical cord clamping with death or severe intraventricular hemorrhage among preterm infants. JAMA, 322:1877-1886, 2019.
  26. Purisch SE, Ananth CV, Arditi B, Mauney L, Ajemian B, Heiderich A, et al. Effect of delayed vs immediate umbilical cord clamping on maternal blood loss in term cesarean delivery:A randomized clinical trial. JAMA, 322:1869-1876, 2019.

Figures

Flowchart illustrating the eligibility assessment process for infants in a medical study, detailing transfers, deaths, and enrollment statistics.
ROC curve illustrating sensitivity and specificity metrics, with a marked cutpoint for analysis.
Table displaying baseline characteristics of participants in a medical study, including sex, gestational age, birth weight, and laboratory data.
Table displaying patients' primary outcomes, including demographics and laboratory data, from a medical study.
Table displaying sensitivity analysis results for various medical parameters related to hospitalization and maternal health.
Table displaying secondary outcomes for erythropoietin administration in treated and untreated patients, including demographic and laboratory data.
Table displaying patients' secondary outcomes for iron supplementation, including demographics and laboratory data.
Table showing the association between treatment for anemia of prematurity and duration of parenteral nutrition or daily weight gain.

ページの先頭へ戻る