Association of hemoglobin and spontaneous closure of the ductus arteriosus during the transitional period in very low birth weight infants

Abstract

OBJECTIVES: To determine the association between plasma hemoglobin (HB) at three time-points (birth, postnatal days 0–3 and 0–10) and spontaneous closure of the ductus arteriosus (sDAC). STUDY DESIGN: A retrospective case-control study of preterm infants born (2013–2016) between 24 and 29 weeks of gestational age (GA) was conducted in a level three perinatal center in Switzerland. We collected hemoglobin at birth, between days 0–3 and 0–10 in two distinct groups: (i) patients treated for a PDA and (ii) patients with spontaneous closure of the ductus arteriosus (sDAC). Antenatal and postnatal demographic data and neonatal morbidity were collected. Bivariate analysis was performed and a stepwise logistic regression was done to investigate factors associated with sDAC. RESULTS: We reviewed the medical chart of 184 premature infants of whom 146 (79.3%) satisfied eligibility criteria. Of these, 74 (51%) were classified as sDAC. Patients with sDAC were older (GA: 28 vs 27, p < 0.001), more stable (clinical risk index for babies score (CRIB score): 2 vs 5, p < 0.001) and had better clinical outcomes than patients who received treatment for a PDA. Infants in the sDAC group had a higher level of hemoglobin during the first ten postnatal days. Multiple logistic regression analysis revealed that lower HB level (day 0–10) were associated with failure of sDAC (p < 0.05). CONCLUSIONS: This is one of the first studies to highlight a potential association between hemoglobin during the transitional period and sDAC. The biological nature of this observation requires prospective clarification.

Proporção de Largura de Distribuição de Hemoglobina/Glóbulos Vermelhos (HRR): Um Novo e Promissor Parâmetro de Glóbulos Vermelhos no Fechamento Ductal

“…No entanto, o efeito dos valores de HB e HCT no hsPDA não é totalmente conhecido. 2 , 3 Joye et al, 10 relataram um aumento na frequência de hsPDA na presença de anemia grave que requer transfusão pós-parto. No mesmo estudo, interpretou-se que um nível de HB mais alto e estável nos primeiros dez dias de vida pode afetar positivamente o fechamento esperado do CA.…”

“…However, the effect of HB and HCT values on hsPDA is not fully known. 2 , 3 Joye et al 10 reported an increase in the frequency of hsPDA in the presence of severe anemia requiring postpartum transfusion. In the same study, it was interpreted that a higher and more stable HB level in the first ten days of life may positively affect the expected closure of the DA.…”

“…This result can be explained according to Joye’s hypothesis, as the HB value was >13.5 g/dL in both groups of patients. 10 According to these results, the increased need for transfusion in patients with severe anemia increases the frequency of hsPDA and may decrease the response of hsPDA to the treatment.…”

“… 1 , 7 , 8 No entanto, existem poucos estudos sobre o efeito dos eritrócitos e parâmetros relacionados no fechamento ductal. 9 , 10 Atualmente, o efeito dos parâmetros hematológicos no PCA não foi totalmente elucidado. Um pequeno número de estudos em adultos concluiu que a proporção (HRR) da largura de distribuição (RDW) da hemoglobina (HB) para os glóbulos vermelhos pode ser um marcador prognóstico em alguns tipos de câncer.…”

“… 1 , 7 , 8 However, few studies exist on the effect of erythrocytes and related parameters on ductal closure. 9 , 10 Currently, the effect of hematological parameters on PDA has not been fully elucidated. A small number of adult studies concluded that hemoglobin (HB)-to-red cell distribution width (RDW) ratio (HRR) might be a prognostic marker in some cancer types.…”