Anemia in the Neonate: The Differential Diagnosis and Treatment

Nassin, Michele L.; Lapping-Carr, Gabrielle; Jong, Jill L. O. de

doi:10.3928/00904481-20150710-08

Cited by 11 publications

(8 citation statements)

References 20 publications

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“…29 Ultimately, the clinical status of the neonate should be taken into consideration to prevent and treat end organ ischemia using specific protocols. 19,20,30,31 Our results call into question the trend of using a restrictive vs a liberal hematocrit strategy in neonatal blood management. Given that mild/moderate anemia in neonates has a strong independent association with mortality, consideration may be given to a target hematocrit level of 40% or more in high-risk infants (ASA status 3-5, weight ≤2 kg, preoperative mechanical ventilation, and inotropic support) to possibly minimize mortality associated with anemia.…”

Section: Discussionmentioning

confidence: 79%

Association of Preoperative Anemia With Postoperative Mortality in Neonates

et al. 2016

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IMPORTANCE Neonates undergoing noncardiac surgery are at risk for adverse outcomes. Preoperative anemia is a strong independent risk factor for postoperative mortality in adults. To our knowledge, this association has not been investigated in the neonatal population. OBJECTIVE To assess the association between preoperative anemia and postoperative mortality in neonates undergoing noncardiac surgery in a large sample of US hospitals. DESIGN, SETTING, AND PARTICIPANTS Using data from the 2012 and 2013 pediatric databases of the American College of Surgeons National Surgical Quality Improvement Program, we conducted a retrospective study of neonates undergoing noncardiac surgery. Analysis of the data took place between June 2015 and December 2015. All neonates (0-30 days old) with a recorded preoperative hematocrit value were included. EXPOSURES Anemia defined as hematocrit level of less than 40%. MAIN OUTCOMES AND MEASURES Receiver operating characteristics analysis was used to assess the association between preoperative hematocrit and mortality, and the Youden J Index was used to determine the specific hematocrit cutoff point to define anemia in the neonatal population. Demographic and postoperative outcomes variables were compared between anemic and nonanemic neonates. Univariate and multivariable logistic regression analyses were used to determine factors associated with postoperative neonatal mortality. An external validation was performed using the 2014 American College of Surgeons National Surgical Quality Improvement Program database. RESULTS Neonates accounted for 2764 children (6%) in the 2012-2013 American College of Surgeons National Surgical Quality Improvement Program databases. Neonates inlcuded in the study were predominately male (64.5%), white (66.3%), and term (69.9% greater than 36 weeks' gestation) and weighed more than 2 kg (85.0%). Postoperative in-hospital mortality was 3.4% in neonates and 0.6% in all age groups (0-18 years). A preoperative hematocrit level of less than 40% was the optimal cutoff (Youden) to predict in-hospital mortality. Multivariable regression analysis demonstrated that preoperative anemia is an independent risk factor for mortality (OR, 2.62; 95% CI, 1.51-4.57) in neonates. The prevalence of postoperative in-hospital mortality was significantly higher in neonates with a preoperative hematocrit level less than 40%; being 7.5% (95% CI, 1%-10%) vs 1.4% (95% CI, 0%-4%) for preoperative hematocrit levels 40%, or greater. The relationship between anemia and in-hospital mortality was confirmed in our validation cohort (National Surgical Quality Improvement Program 2014). CONCLUSIONS AND RELEVANCE To our knowledge, this is the first study to define the incidence of preoperative anemia in neonates, the incidence of postoperative in-hospital mortality in neonates, and the association between preoperative anemia and postoperative mortality in US hospitals. Timely diagnosis, prevention, and appropriate treatment of preoperative anemia in neonates might improve survival.

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Section: Discussionmentioning

confidence: 79%

Association of Preoperative Anemia With Postoperative Mortality in Neonates

et al. 2016

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“…The conservative treatment for PKD is largely supportive in the clinic, including optimal red cells transfusion, iron chelation, and splenectomy as necessary . Gene therapy is under study as an alternative approach and has been demonstrated to be effective in animal models, but its application in humans is still limited .…”

Section: Discussionmentioning

confidence: 99%

A novel PKLR gene mutation identified using advanced molecular techniques

Luo

Yonghong

Jia

et al. 2018

Pediatric Transplantation

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This study's purposes were to diagnose intractable hemolytic anemia and to provide guiding treatment for the affected family members. We performed NGS in a panel of 600 genes for blood diseases on a patient with obscure hemolytic anemia and her parents. We confirmed the diagnosis of pyruvate kinase deficiency, identified a novel homozygous mutation of the PKLR gene (NM_000298: exon 6: c.T941C: p.I314T), and ruled out other blood diseases in the Chinese family. Furthermore, amniotic fluid was taken from the mother during the second trimester, and DNA was extracted to analyze the type of PKLR gene mutation. The proband received cord blood and bone marrow from the second child of the mother for hematopoietic stem cell transplantation and achieved normal hematopoiesis. The genetic characterization analysis and genotype-phenotype correlation study of PKLR gene suggested that NGS was an effective method to confirm the molecular diagnosis of intractable hemolytic anemia. The identification of the mutation aided in prenatal diagnosis in the second pregnancy and the effective clinical management of the affected family.

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“…Evaluation of the hemolytic anemia in newborn infants should include blood typing of the mother and the infant and direct antiglobulin testing (DAT), to detect immune-mediated hemolysis. [29].…”

Section: Laboratory Diagnosismentioning

confidence: 99%

“…Glycerol lysis and Pink tests are also used as first-line laboratory tests. Other more specialized tests for erythrocyte membrane defects include: flow cytometry, ektacytometry and SDS-PAGE of erythrocyte membrane proteins [28,29,46].…”

Section: Laboratory Diagnosismentioning

confidence: 99%

Neonatal Anemia

Dionísio¹,

Dzirba²

2022

Topics on Critical Issues in Neonatal Care

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Neonatal anemia and iron deficiency are frequent founds in neonatal intensive care units (NICUs). The three major causes of anemia in neonates are blood loss, reduced red blood cell production, and increased degradation of the erythrocytes. Premature infants in ICUs have high levels of iron deficiency, and ascertaining the cause of anemia in this group of patients can be a challenge in clinical practice. This chapter provides an updated review of neonatal anemia. It will concern the pathophysiology of neonatal anemia in term and preterm infants and a detailed discussion of the traditional and innovative laboratory tests for diagnosis and assessment of this condition in the ICUs

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Anemia in the Neonate: The Differential Diagnosis and Treatment

Cited by 11 publications

References 20 publications

Association of Preoperative Anemia With Postoperative Mortality in Neonates

Association of Preoperative Anemia With Postoperative Mortality in Neonates

A novel PKLR gene mutation identified using advanced molecular techniques

Neonatal Anemia

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