Fetal haemoglobin and bronchopulmonary dysplasia in neonates: an observational study

Abstract

ObjectiveEarly decrease in fetal haemoglobin (HbF) is an indicator of loss of endogenous blood components that might have predictive value for development of bronchopulmonary dysplasia (BPD). The link between HbF and BPD has not been evaluated.DesignRetrospective observational study.SettingTertiary level neonatal intensive care unit, referral centre for Southern Sweden.Patients452 very preterm infants (<30 gestational weeks) born 2009–2015.InterventionsRegular clinical practice.Main outcome measuresMean HbF, haemoglobin (Hb) and partial oxygen pressure (PaO2) levels calculated from 11 861 arterial blood gas analyses postnatal week 1. Relationship between HbF (%) and BPD (requirement of supplemental oxygen at 36 weeks’ postmenstrual age) and the modifying influence of PaO2 (kPa) and total Hb (g/L) was evaluated.ResultsThe mean gestational age (GA) at birth was 26.4 weeks, and 213 (56%) infants developed BPD. A 10% increase in HbF was associated with a decreased prevalence of BPD, OR 0.64 (95% CI 0.49 to 0.83; p<0.001). This association remained when adjusting for mean PaO2 and Hb. Infants with an HbF in the lowest quartile had an OR of 27.1 (95% CI 11.6 to 63.4; p<0.001) for development of BPD as compared with those in the highest quartile. The area under the curve for HbF levels and development of BPD in the full statistical model was 0.871.ConclusionsEarly rapid postnatal decline in HbF levels was associated with development of BPD in very preterm infants. The association between HbF and BPD was not mediated by increased oxygen exposure. The potential benefit of minimising loss of endogenous blood components on BPD outcome will be investigated in a multicentre randomised trial.

Fetal Hemoglobin and Tissue Oxygenation Measured With Near-Infrared Spectroscopy—A Systematic Qualitative Review

“…Higher FHbF is already reported to be a protective factor for development of ROP in very preterm infants (8). In the latest published observational study on HbF and bronchopulmonary dysplasia (BPD), rapid postnatal decline in FHbF levels rather than an increased oxygen exposure was associated with development of BPD in very preterm infants (34). A randomized trial addressing a similar question is already recruiting [Preservation of Blood in Extremely Preterm Infants (LIM) ClinicalTrials.gov Identifier: NCT04239690].…”

Morphology and biological data in cord blood eryhtrocyte units resembles adult units after processing and storage – Meets current quality recommendations

“…Therefore, using UCB for transfusions instead of blood from adult donors could be an alternative to reduce anemia and the risk for hyperoxemia and fluctuating oxygenation which are prominent risk factors for neonatal morbidities. In accordance, frequent diagnostic blood sampling in combination with blood transfusions in very preterm infants has been associated with an increased risk for neonatal morbidities such as bronchopulmonary dysplasia (BPD) and rethinopathy of prematurity (ROP) [21,22]. ROP is a leading cause of childhood blindness worldwide; 1.2 percent of premature infants (year 2010) developed ROP [23,24].…”

Interventions to minimize blood loss in very preterm infants—A systematic review and meta-analysis

“…Blood loss due to sampling is considered a major cause of anemia in preterm infants. In fact, during the first weeks of life, extracted blood volume in critically sick neonates may be as much as 58% of the total blood volume [ 7 – 9 ]. In extremely premature infants, there is a speculated association between blood loss-induced anemia and both NEC [ 10 ] and BPD development [ 9 , 11 ].…”

“…In fact, during the first weeks of life, extracted blood volume in critically sick neonates may be as much as 58% of the total blood volume [ 7 – 9 ]. In extremely premature infants, there is a speculated association between blood loss-induced anemia and both NEC [ 10 ] and BPD development [ 9 , 11 ]. Anemia is usually treated with adult blood transfusions and several studies have hypothesized an association between transfusion rate and BPD, retinopathy of prematurity (ROP), and adverse neurodevelopmental outcome in extremely preterm infants [ 11 , 12 ].…”

“…In the same cohort, survival with any major neonatal morbidity was 62%. Anemia and blood transfusions have been associated with neonatal morbidity [ 9 – 11 ]. However, data from observational studies do not properly indicate whether this is only an association of poorer clinical conditions.…”