Newborn Thyroid Screening: Influence of Pre-Analytic Variables on Dried Blood Spot Thyrotropin Measurement.

BACKGROUND: Measuring thyrotropin (TSH) eluted from a dried blood spot (DBS) is used to screen an estimated 30 million newborns annually for congenital hypothyroidism (CH). Newborn thyroid screening has eliminated cretinism from the industrialized world and decreased the adverse effects of unrecognized CH on neurocognitive development. Hematocrit, a pre-analytic variable that affects the measurement of TSH from a DBS, contributes to the imprecision of DBS TSH measurement and could account for false-negative and false-positive DBS newborn screening test results. To assess whether variations in hematocrit found in newborns have a clinical effect in DBS-based newborn thyroid screening, the effects of hematocrit variability on the measurement of DBS TSH were studied. METHODS: U.S. Centers for Disease Control and Prevention procedures for manufacturing DBS performance testing standards were used to generate DBSs from blood samples, with hematocrits of 35%, 40%, 45%, 50%, 55%, 60%, and 65% and serum TSH concentrations of 6.3 ± 0.4 and 26.6 ± 8.0 mIU/L. TSH was measured in the eluates of four replicate DBS 3 mm punches at each hematocrit using the Thailand Ministry of Public Health Newborn Screening Operation Center enzyme-linked immunosorbent assay. Data were analyzed using a linear mixed-effects model. RESULTS: Based on the mixed-effects model, hematocrit significantly affected DBS TSH measurement (p < 0.001). A 1% increase in hematocrit resulted in a 0.06 mIU/L decrease in eluate TSH when TSH was 6.3 + 0.4 mIU/L, and a 0.21 mIU/L decrease in eluate TSH when TSH was 26.6 + 8.0 mIU/L. CONCLUSIONS: DBS TSH is significantly affected by the blood sample hematocrit. The pre-analytic variability due to hematocrit is independent of TSH assay sensitivity, specificity, precision, repeatability, and reference intervals. The effect of hematocrit on DBS TSH measurement is clinically relevant, could account for geographic and ethnic variation in the incidence of CH, and may result in both false-positive and false-negative CH screening results. Individual newborn and population-specific hematocrit correction factors may improve the precision of DBS TSH measurement.

Micronutrient supplementation adherence and influence on the prevalences of anemia and iron, zinc and vitamin A deficiencies in preemies with a corrected age of six months.

OBJECTIVE: To analyze adherence to the recommended iron, zinc and multivitamin supplementation guidelines for preemies, the factors associated with this adherence, and the influence of adherence on the occurrence of anemia and iron, zinc and vitamin A deficiencies. METHODS: This prospective cohort study followed 58 preemies born in 2014 until they reached six months corrected age. The preemies were followed at a referral secondary health service and represented 63.7% of the preterm infants born that year. Outcomes of interest included high or low adherence to iron, zinc and multivitamin supplementation guidelines; prevalence of anemia; and prevalences of iron, zinc, and vitamin A deficiencies. The prevalence ratios were calculated by Poisson regression. RESULTS: Thirty-eight (65.5%) preemies presented high adherence to micronutrient supplementation guidelines. At six months of corrected age, no preemie had vitamin A deficiency. The prevalences of anemia, iron deficiency and zinc deficiency were higher in the low-adherence group but also concerning in the high-adherence group. Preemies with low adherence to micronutrient supplementation guidelines were 2.5 times more likely to develop anemia and 3.1 times more likely to develop zinc deficiency. Low maternal education level increased the likelihood of nonadherence to all three supplements by 2.2 times. CONCLUSIONS: Low maternal education level was independently associated with low adherence to iron, zinc and vitamin A supplementation guidelines in preemies, which impacted the prevalences of anemia and iron and zinc deficiencies at six months of corrected age.

Micronutrient supplementation adherence and influence on the prevalences of anemia and iron, zinc and vitamin A deficiencies in preemies with a corrected age of six months

OBJECTIVE: To analyze adherence to the recommended iron, zinc and multivitamin supplementation guidelines for preemies, the factors associated with this adherence, and the influence of adherence on the occurrence of anemia and iron, zinc and vitamin A deficiencies. METHODS: This prospective cohort study followed 58 preemies born in 2014 until they reached six months corrected age. The preemies were followed at a referral secondary health service and represented 63.7% of the preterm infants born that year. Outcomes of interest included high or low adherence to iron, zinc and multivitamin supplementation guidelines; prevalence of anemia; and prevalences of iron, zinc, and vitamin A deficiencies. The prevalence ratios were calculated by Poisson regression. RESULTS: Thirty-eight (65.5%) preemies presented high adherence to micronutrient supplementation guidelines. At six months of corrected age, no preemie had vitamin A deficiency. The prevalences of anemia, iron deficiency and zinc deficiency were higher in the low-adherence group but also concerning in the high-adherence group. Preemies with low adherence to micronutrient supplementation guidelines were 2.5 times more likely to develop anemia and 3.1 times more likely to develop zinc deficiency. Low maternal education level increased the likelihood of nonadherence to all three supplements by 2.2 times. CONCLUSIONS: Low maternal education level was independently associated with low adherence to iron, zinc and vitamin A supplementation guidelines in preemies, which impacted the prevalences of anemia and iron and zinc deficiencies at six months of corrected age.

Factores maternos relacionados con la anemia en recién nacidos pretérminos. Hospital Dr. Verdi Cevallos Balda. Portoviejo. Ecuador. Abril septiembre 2015 / Maternal factors related to anemia in preterm infants. Hospital Dr. Verdi Cevallos Balda. Portoviejo. Ecuador. April september 2015

La anemia en los neonatos pretérrminos definida como la disminución de los glóbulos rojos, hemoglobina o del hematocrito relacionados a la edad gestacional, es una de las enfermedades más frecuentes a nivel mundial, por ello se ha realizado una investigación que relacione los factores de riesgos maternos que se involucran con la aparición de la anemia en prematuros, en el periodo de abril a septiembre 2015 en el Hospital Dr. Verdi Cevallos Balda. De tipo descriptivo, prospectivo de diseño no experimental con una muestra de 32 pacientes se obtuvo como resultado que el 56 por ciento de los pacientes correspondió al sexo masculino, el 72 por ciento se encontró entre las 32 a 37 semanas degestación, en el 75 por ciento de los casos se realizó un oportuno pinzamiento del cordón umbilical, la causa más común de anemia neonatal en estos pacientes fueron las hemorragias internas en el 25 por ciento de los casos seguido de las malformaciones de vasos umbilicales en el 22 por ciento de los casos las madres de los afectados eran en el 38 por ciento de los casos mujeres añosas y multiparas y el 25 por ciento de las madres tenían como antecedentes patológico placenta previa, se recomendó controles prenatales mensuales para prevenir dichas complicaciones, y la socialización del mismo.

Anemia in preterm infants is called as decreased red blood cells, hemoglobin or hematocrit related to gestational age to be one of the first most common diseases worldwide, especially those in developing countries as the ours has been chosen this topic for an investigation linking maternal risk factors that are involved with the development of neonatal anemia in prematures study in the period from April to September 2015in Dr. Verdi Cevallos Balda Hospital. Descriptive, prospective non experimental design with a sample of 32 patients resulting in 56 percent of patients corresponded to male, 72 percent was found between 32-37 weeks of gestation, 75 percent cases, an oppor pinzaminto umbilical cord was performed, the most common cause of neonatal anemia in these patients were internal bleeding in 25 percent of cases followed by umbilical vessels malformations in 22 percent of cases mothers were affected in 38 percent of cases añosas and multiparous women and 25 percent of mothers had pathological history as placenta previa, monthly prenatal checkups are recommended to prevent nutritional deficiencies and complications, proper management as indicated by the regulations msp and socialization of it.

Decreased hazard of necrotizing enterocolitis in preterm neonates receiving red cell transfusions.

BACKGROUND AND OBJECTIVES: Many observational studies reporting a temporal association between red cell transfusions (RBCTs) and necrotizing enterocolitis (NEC) in preterm infants fail to take into account RBCTs in infants without NEC. The objective of this study was to investigate the association between RBCTs and NEC in an analytical retrospective cohort study with minimization of selection and measurement bias and controlling for clinical covariates. METHODS: Inborn preterm infants [23-32 weeks gestational age (GA)] without major congenital anomalies were eligible. Association of RBCT and modified Bell's Stage ≥2A NEC was explored using bivariate analyses and verified using multivariable Cox regression. RESULTS: Of 627 eligible infants, 305 neither received RBCT nor developed NEC and 12 developed NEC prior to RBCT. Of 310 infants with RBCT, 27 developed NEC. Compared to infants without NEC, infants with NEC received significantly lower number of RBCTs before diagnosis of NEC (p = 0.000). On multivariable Cox regression controlling for clinical covariates, dichotomous RBCT exposure was associated with 60% reduced hazard for NEC. CONCLUSIONS: RBCT exposure was associated with decreased hazards for NEC in preterm infants in this study; factors previously reported to be associated with NEC remained statistically significant predictors.

Incidence of spontaneous twin anemia-polycythemia sequence in monochorionic-diamniotic twin pregnancies: Single-center prospective study.

AIM: The purpose of this study was to prospectively estimate the incidence of spontaneous twin anemia-polycythemia sequence (TAPS) in monochorionic-diamniotic twin pregnancies. METHODS: We prospectively examined umbilical cord hemoglobin (Hb) and reticulocyte count of consecutive monochorionic-diamniotic twin pregnancies delivered at Seirei Hamamatsu General Hospital from December 2006 to September 2013. We excluded cases of twin-twin transfusion syndrome, intrauterine fetal demise, and missing data (Hb and reticulocyte count missing from the medical record). TAPS was diagnosed using the postnatal criteria of intertwin Hb difference >8.0 g/dL and reticulocyte count ratio >1.7. Acute feto-fetal hemorrhage was defined as Hb difference >7 g/dL and reticulocyte count ratio <1.7. RESULTS: A total of 185 monochorionic-diamniotic twin pregnancies were included in this study. Three fulfilled the diagnostic criteria for postnatal TAPS, and one fulfilled the diagnostic criteria for acute feto-fetal hemorrhage. CONCLUSION: The incidence of spontaneous TAPS in monochorionic-diamniotic twin pregnancies was 1.6% (3/185) at Seirei Hamamatsu General Hospital.

What kind of milk can prevent infant's sideropenic anemia--comparative study.

INTRODUCTION: The most common cause of sideropenic anemia in infants, during the period of their fast growth and development, is inadequate nutrition or insufficient intake of food rich in iron. The aim of this paper is to provide the insight into the problem of anemia and to emphasize nutrition as an important etiologic factor in the onset and prevention of anemia in infants. MATERIAL AND METHODS: Two retrospective studies were conducted at the Institute for Child and Youth Healthcare of Vojvodina. Department for Infant and Small Children's Pathology. The first study covered the period of eight years (1988-1995), and it included a total of 507 children, aged 1-24 months. The second study covered the period of two years (2010-2011) and a total of 290 children aged 1-12 months were included. The diagnosis of anemia was made according to clinical examination or after taking routine laboratory tests. According to the criteria of the World Health Organization, all children were divided into those with severe, moderate or mild anemia. RESULTS: Out of 507 children examined in the first study, 333 (65.68%) were breastfed, while 174 (34.32%) had never been breastfed. In the second study, 206 (71.03%) out of 290 children were breastfed, while 56 (19.31%) had never been breastfed. In both studies the highest percentage of children breastfed for the longest period was among children with mild form of anemia, while the children who were breastfed for the shortest period had severe anemia. In addition, the highest percentage of anemic children was supplementary fed with cow's milk in both studies. CONCLUSION: Short natural diet, early introduction of supplementation and choice of milk could be determining factors in the development and manifestation of anemia.

Impact of physician awareness on diagnosis of fetomaternal hemorrhage.

BACKGROUND: Fetomaternal hemorrhage (FMH) is a poorly understood condition in which the placenta allows transmission of fetal whole blood to the mother. FMH can cause fetal anemia resulting in critical illness, death or lifelong disability. Ascertainment of the incidence of FMH is limited by reliance on retrospective studies that are dependent on a diagnosis of FMH being made at the time of patient presentation. OBJECTIVE: To determine whether the diagnosis of FMH is made more frequently after an educational intervention to increase physician awareness of the condition. METHODS: This is a retrospective cohort study of all neonates born at our institution from 1988 through 2010. The medical records of all neonates diagnosed with anemia in the first 24 h of life were reviewed. The incidence of FMH as a documented etiology of anemia was compared between infants born before and after our educational intervention. RESULTS: Of 124,738 births during the study period, 572 neonates with neonatal anemia were identified. A total of 23 cases of FMH demonstrated by positive Kleihauer-Betke testing occurred in our cohort. The incidence of diagnosed FMH prior to our intervention was 22 per 1,000 anemic neonates compared to 182 per 1,000 afterwards (p < 0.001), while the incidence of neonatal anemia remained unchanged (p = 0.377). CONCLUSIONS: FMH may be a significant cause of neonatal anemia. Diagnosis of FMH is highly dependent on physician awareness of the condition. Incorrect or absent diagnosis of the etiology of neonatal anemia has significant implications for our understanding of the epidemiology of FMH.

[Evaluation of the practice of transfusion in the anemia in preterm infants]. / Evaluation de la pratique transfusionnelle dans l'anemie du prémature.

UNLABELLED: The early anemia in preterm infants, usually implies as a remedy, the use of erythrocyte transfusions indicated according to transfusion criteria which are variable from one neonatal center to another. OBJECTIVE: To evaluate our practice of transfusions concerning the anemia in preterm infants. METHODS: A descriptive study on 113 preterm infants whose gestational age is < 37 weeks and who were hospitalised in Neonatal Service at the Infants Hospital at Rabat during the year 2006, by recording the gestational age, the weight at birth, the rate of haemoglobin and hematocrit at the first admission of the infant and before his first blood transfusion and finally the clinical and biological indications. In order to analyse the criteria of blood transfusion, we have compared between two groups: a group A of 65 transfused preterm infants and a group B of 48 non-transfused with the test of Chi2 and t Student at threshold of P < 0,005. RESULTS: The medium gestational age was that of 33 weeks and the medium weight at birth was 1.672 g. 57,5% of preterm infants were transfused. The preterm babies who has received transfusion compared to those who have not, are significantly more preterm, their weight at birth is weak and the time of hospitalisation is longer, having had more nosocomial infections, postnatal bleeding and their haemoglobin and hematocrit rate at birth is lower (P < 0,001). 41,5% of transfused infants had presented clinical signs of anemia and had been transfused one week earlier than asymptomatic infants and had elevated rates of haemoglobin and hematocrit (P < 0,005). CONCLUSION: The use of blood transfusion is frequent in our context and implies preventive measures to reduce it.

Severe neonatal anemia from fetomaternal hemorrhage: report from a multihospital health-care system.

OBJECTIVE: The incidence of fetomaternal hemorrhage that is severe enough to cause neonatal anemia is not known. Owing to its relative rarity, much of the literature describing this condition is in the form of case reports and small case series. We performed a large, muiticentered, sequential, case series to determine the incidence, antecedents and outcomes. STUDY DESIGN: From the multicentered databases of Intermountain Healthcare, we obtained records of all neonates with hematocrit (Hct) <30% or hemoglobin (Hgb) <10 g dl(-1) on the day of birth, who had Kleihauer-Betke staining or flow cytometric evidence of fetomaternal hemorrhage. RESULT: Among 219,853 live births, 24 had anemia with evidence of fetomaternal hemorrhage (incidence estimate, 1 per 9160 live births). The initial Hgb ranged from 1.4 to 10.2 g dl(-1) (Hct 29.8%). The initial Hgb was <7 g dl(-1) in 18 (67%), <5 g dl(-1) in 12 (50%) and was <3 g dl(-1) in 7 (29%). All 7 mothers in whom neonatal Hgb was <3 g dl(-1) had reported absent fetal movement, as did 13 of 18 mothers when the initial Hgb was <7 g dl(-1). Outcomes were poorer in those with the lowest initial Hgb; in the two lowest, one died on day 1, and the other developed a grade 4 intraventricular hemorrhage (IVH). The adverse outcomes of death, IVH, periventricular leukomalacia, bronchopulmonary dysplasia or hypoxic-ischemic encephalopathy were common; occurring in 71% (17 of the 24), including all with an initial Hgb <5 g dl(-1) and all born at ≤35 weeks of gestation. CONCLUSION: Fetomaternal hemorrhage is a rare but sometimes devastating condition. Those with fetomaternal hemorrhage and an initial Hgb of <5 g dl(-1) are expected to need resuscitation at birth, to receive emergent transfusion support and to be at risk for death and major morbidities. Antenatal suspicion of this diagnosis should occur when absent fetal movement is reported. Improvements in rapid diagnosis are needed to prepare first responders and transfusion services.

The effects of malaria and intermittent preventive treatment during pregnancy on fetal anemia in Malawi.

BACKGROUND: Fetal anemia is common in malarious areas and is a risk factor for infant morbidity and mortality. Malaria during pregnancy may cause decreased cord hemoglobin (Hb) and fetal anemia among newborns. Intermittent preventive treatment during pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) is protective against malaria but may also affect hematopoiesis and contribute to fetal anemia. METHODS: Peripheral, placental, and cord blood were examined for malaria parasitemia and Hb concentration in a cross-section of 3848 mothers and infants delivered at Queen Elizabeth Central Hospital in Blantyre, Malawi between 1997 and 2006. Unconditional linear and logistic regressions were performed with multiple imputation for missing covariates to assess the associations between malaria, IPTp with SP, and fetal anemia. RESULTS: The overall prevalence of fetal anemia was 7.9% (n = 304). Malaria parasitemia at delivery was associated with an adjusted decrease in cord Hb of -0.24 g/dL (95% confidence interval [CI], -.42 to -.05). The adjusted prevalence odds ratio for the effect of malaria on fetal anemia was 1.41 (95% CI, 1.05-1.90). Primigravidae who did not take IPTp had infants at highest risk for fetal anemia, and density of parasitemia was correlated with the decrease in cord Hb. There was no significant association between SP use and cord Hb or fetal anemia. CONCLUSIONS: Malaria during pregnancy, but not IPTp, decreases cord Hb and is a risk factor for fetal anemia in Malawi. Intermittent preventive treatment during pregnancy with SP may continue to be safe and effective in preventing malaria during pregnancy and fetal anemia despite development of SP resistance.

Relationship of neonatal treatments with the development of necrotizing enterocolitis in preterm infants.

BACKGROUND: Although many therapeutic interventions are necessary for the survival of the preterm infant, understanding the potential effects of these treatments is important to decrease the rate of necrotizing enterocolitis (NEC) in preterm infants. OBJECTIVE: The aim of this study was to examine the relationship between preterm infant treatments administered prior to the development of NEC, specifically the number of packed red blood cell (PRBC) transfusions, weeks of antibiotic therapy for nosocomial infection, and number of mechanical ventilation days, and the development of NEC in preterm infants. METHODS: A retrospective cohort controlled study design examining 4 years of raw data of preterm infants between the gestational ages of 23 and 30 6/7 weeks was used. Of the 549 infants, there were 65 cases of NEC. Using logistic regression, the relationship between NEC and PRBC transfusions administered prior to NEC, number of mechanical ventilation days prior to NEC, and number of weeks of antibiotic therapy for nosocomial infections experienced prior to NEC (proxy for nosocomial infection) were examined. RESULTS: Preterm infants from 23 to 30 6/7 weeks who developed NEC experienced significantly more PRBC transfusions and more weeks of antibiotic therapy for nosocomial infection prior to the development of NEC than did infants who did not develop NEC. There was no relationship between mechanical ventilation days and the development of NEC. DISCUSSION: Future research should focus on causal relationships between NEC and PRBC administration and the reduction of nosocomial infections in preterm infants to minimize risk for NEC in this population.

Cord blood iron profile and breast milk micronutrients in maternal iron deficiency anemia.

BACKGROUND: Micronutrient deficiencies among pregnant women are widespread in low-income countries, including Egypt. Iron deficiency anemia (IDA) is the most frequent nutritional deficiency during pregnancy, with an impact on maternal and fetal morbidity and mortality. We aimed to evaluate the effect of maternal IDA and nutritional status on birth anthropometry, cord blood iron profile and breast milk micronutrients in 50 anemic (hemoglobin <11 g/dl) and 30 healthy pregnant women. PROCEDURE: Maternal and neonatal anthropometric measures were recorded. Hemoglobin, red blood cell (RBC) indices, and indices of iron nutriture were measured in maternal and cord blood. Breast milk minerals; iron, copper, zinc, calcium, and magnesium were assessed. RESULTS: Hemoglobin, RBC indices, and iron profile showed significant differences in the neonates born to anemic mothers compared to controls, particularly in moderate to severe anemia and linear correlations with maternal hemoglobin, iron, and ferritin levels were found (P < 0.01). Anthropometric measurements of anemic mothers and their neonates were positively correlated (P < 0.05). Breast milk micronutrients were significantly reduced in all anemic mothers showing significant relations with maternal serum iron (P < 0.01). CONCLUSIONS: Maternal IDA wields a significant influence on maternal and fetal nutritional status. IDA during pregnancy adversely affects both cord blood iron and breast milk mineral status, particularly in moderate to severe anemia and concurrent micronutrient deficiencies occur in maternal IDA. Further investigations including larger population of pregnant women with severe anemia are needed to verify the nutritional interrelation between maternal anemia and breast milk mineral status.

Fetal anemia of unknown cause--a diagnostic challenge.

PURPOSE: To assess the spectrum of underlying diseases in cases of fetal anemia in which the cause was unknown at the time of first and second transfusion or thereafter. MATERIALS AND METHODS: All patients who underwent intrauterine transfusion were identified in the perinatal databases of two tertiary referral centers for prenatal medicine and treatment between 2002 and June 2010. RESULTS: 82 fetuses received intrauterine transfusion in the study period. A total of 356 transfusions were performed in these patients. The causes of fetal anemia in our cohort were alloimmunization (32), parvovirus infection (23), feto-fetal transfusion syndrome (9), sacrococcygeal teratoma (2) and cytomegalovirus infection (1). In the remaining 15 cases, the cause of fetal anemia was unknown at the time of first and second transfusion, and could only be ascertained in the further course of pregnancy, in the postnatal period or was ultimately left in doubt. In all cases markedly elevated peak systolic velocities in the middle cerebral artery accurately predicted fetal anemia. The final diagnosis in these cases was fetomaternal hemorrhage (4), Blackfan-Diamond anemia (1), diffuse neonatal hemangiomatosis with chorangioma (1), kaposi-like hemangioendothelioma (1), elliptocytosis (1), neonatal hemochromatosis (1), mucopolysaccharidosis type VII (1) and in 5 cases the cause of fetal anemia remained unexplained. The latter 5 cases had an uneventful postnatal course and did not require further transfusions in infancy. CONCLUSION: In cases of fetal anemia with negative indirect Coombs test and TORCH serology, rare causes of anemia have to be considered. Fetal studies should therefore include reticulocyte count, parameters of hemolysis, peripheral blood smear and fetal liver function tests. Maternal studies should involve a search for fetal red cells using flow cytometry rather than Kleihauer-Betke test.

Risk factors of neonatal anemia in placenta previa.

OBJECTIVES: Placenta previa is a major cause of neonatal anemia. The purpose of this study was to elucidate the risk factors of neonatal anemia in placenta previa. METHODS: The study was conducted on 158 placenta previa patients at 3 hospitals in affiliation with the Catholic Medical Center, Seoul, Korea from May 1999 through December 2009. The subjects were divided in to 2 groups: 47 placenta previa patients with neonatal anemia, and 113 placenta previa patients without neonatal anemia. The subjects' characteristics were compared. Logistic regression was used to control for confounding factors. RESULTS: Anterior placental location (OR 2.48; 95% CI: 1.20-5.11) was an independent risk factor of neonatal anemia after controlling for potential confounders. CONCLUSION: To manage neonatal anemia in placenta previa patients, obstetricians should do their best to detect placental location. Pediatricians should consider the high possibility of neonatal anemia in cases involving anterior placental location.

Increased odds of necrotizing enterocolitis after transfusion of red blood cells in premature infants.

OBJECTIVES: To determine if infants with very low birth weight who receive packed red blood cell (PRBC) transfusions have increased odds of developing necrotizing enterocolitis (NEC), to determine the rate of NEC after PRBC transfusion, and to characterize the blood transfused preceding the onset of NEC. STUDY DESIGN: A retrospective cohort design was used. The study population included infants with a birth weight of <1500 g who were from a single center. NEC after transfusion was defined as NEC that occurred in the 48 hours after initiation of PRBC transfusion. Statistical analysis included unadjusted and multivariable analyses. RESULTS: The study sample included 2311 infants. A total of 122 infants (5.3%) developed NEC, and 33 (27%) of 122 NEC cases occurred after transfusion. NEC occurred after 33 (0.5%) of 6484 [corrected] transfusions. Infants who received a transfusion had increased adjusted odds (odds ratio: 2.3 [95% confidence interval: 1.2-4.2]) of developing NEC compared with infants who did not receive a transfusion. PRBCs transfused before NEC were predominantly (83%) from male donors and were a median of 5 days old. CONCLUSIONS: In our study sample, PRBC transfusion was associated with increased odds of NEC. The rate of NEC after transfusion was 1.4%. From our data we could not determine if PRBC transfusions were part of the causal pathway for NEC or were indicative of other factors that may be causal for NEC.

Perinatal variables and neonatal outcomes in severely growth restricted preterm fetuses.

OBJECTIVE: To investigate the impact of severe preterm intrauterine growth restriction on perinatal and neonatal outcomes. DESIGN: Retrospective cohort study. SETTING: Tertiary referral fetal medicine unit in London. POPULATION: A total of 60 pregnancies affected by early onset severe intrauterine growth restriction with fetal abdominal circumference below the third centile and abnormal arterial or venous Dopplers between October 2003 and October 2007, and control cohort of 77 appropriate-for-gestational age preterm neonates. METHODS: Cases were identified from the departmental databases. The neonatal outcomes in 44 growth restricted survivors were compared with 77 gestation matched appropriate-for-gestational age preterm neonates. MAIN OUTCOME MEASURES: Neonatal morbidity and neonatal mortality. RESULTS: Of the 60 pregnancies affected by severe intrauterine growth restriction, seven were terminated, nine resulted in stillbirth and 44 resulted in live births. The growth restricted neonates had increased odds of developing respiratory distress compromise (odds ratio (OR) 2.5, 95% confidence interval (CI) 1.1-6.2) and thrombocytopenia (OR 9.4, 95%CI 2.9-30.8) in comparison to average-for-gestational age cohorts. We also noted an increased risk of neonatal sepsis (OR 2.5, 95%CI 1.1-6.0) and necrotising enterocolitis (OR 9.7, 95%CI 1.1-86.0). Sepsis was the major contributing factor towards neonatal mortality in the growth restricted cohorts. CONCLUSION: Despite intensive fetal surveillance and tertiary level neonatal care, the survival for growth restricted fetuses before 28 weeks gestation remains poor with neonatal outcome predominantly affected by respiratory morbidity, sepsis and metabolic compromise.

[The impact of premature rupture of membranes (PROM) on neonatal outcome]. / Wplyw przedwczesnego pekniecia blon plodowych (PROM) na stan noworodka.

OBJECTIVE: The aim of the following study was to evaluate the impact of premature rupture of membranes (PROM) on neonatal outcome, particularly on the incidence of intrauterine infections (IUI). MATERIAL AND METHODS: The study included 428 newborns, born after PROM and hospitalized in the Department of Neonatology at Poznan University of Medical Sciences in 2006. The influence of selected variables on the development of IUI and other complications was analyzed. RESULTS: IUI occurred in 124 newborns (29%). The odds ratio (OR) of IUI incidence increased with decreasing gestational age, birth weight and Apgar score, as well as with increasing duration of the time between PROM and birth, called the latency period. Logistic regression showed that IUI was significantly influenced by the latency period (OR=1.37; 95% CI: 1.10-1.71; p<0.01), gestational age (OR=2.29; 95% CI: 1.59-3.30; p<0.0001) and 5-minute Apgar score (OR=2.50; 95% CI: 1.57-3,98; p<0.001). The incidence of other complications such as prematurity respiratory distress syndrome, respiratory failure, intraventricular hemorrhage, and anemia increased with the duration of the latency period. Compared to uninfected infants, the infected ones were characterized by lower birth weight, lower gestational age, lower Apgar score and poorer laboratory results. CONCLUSIONS: Among neonates born from pregnancies complicated with PROM, the incidence of IUI is significantly influenced by the latency period, gestational age and 5-minute Apgar score. The incidence of other complications increases with the duration of the latency period. Prematurity is an important contributor to morbidity in this group of neonates.

Twin anemia polycythemia sequence from a prenatal perspective.

OBJECTIVES: To describe the prevalence, management and outcome of spontaneous twin anemia polycythemia sequence (TAPS) diagnosed in the prenatal period. METHOD: Retrospective analysis of 142 consecutive monochorionic twin pregnancies not diagnosed with twin to twin transfusion syndrome. TAPS cases were identified based on the presence of discordant middle cerebral artery peak systolic velocity (MCA-PSV) measurements and signs suggestive of a chronic intertwin transfusion imbalance: either an elevated reticulocyte count in the anemic twin or the presence of few small unidirectional anastomoses during fetoscopy or at postnatal placental examination. RESULTS: Three cases were identified, giving an estimated prevalence of 2%. Prenatal interventions were tailored to the characteristics of each case and consisted of intrauterine transfusion and interruption of the shared circulation by cord coagulation or laser separation. CONCLUSION: In monochorionic twin pregnancies, TAPS is an uncommon prenatal finding. Nonetheless, its incidence seems high enough to recommend screening for this disease by MCA-PSV measurements.