Abstract:Even low levels of PAE can cause adverse foetal effects and not just in the brain. It is not currently possible to determine a safe period and level when alcohol consumption would not affect the foetus.
“…Similarly, Nelle et al [28] ( n = 33) also noticed a significant drop in heart rate (from 161 to 149 beats per min; p = 0.005) following RCBT [28]. Contrastingly Dani et al [29] ( n = 14) and Alkalay et al [30] ( n = 32) found no difference in heart rate following RBCT. However, it was subsequently demonstrated that heart rate correlates positively with the measured blood volume of preterm infants born at 24–32 weeks of gestation [31].…”
Section: Physiological Adaptive Response To Anaemia and Blood Transfumentioning
The current evidence regarding the indication, advantages and risks of red blood cell transfusion (RBCT) for preterm infants is discussed. This is an important area in Neonatology to be examined given that 90% of extremely low birth weight infants receive RBCT and many controversies remain regarding when to transfuse and the risks of RBCT. The various treatment thresholds and guidelines used are presented and we compare the short-term clinical benefits of liberal and restrictive RBCT in preterm infants; the majority of these are equivocal and sadly long-term outcome data is limited. The latest evidence on how anaemia and blood transfusion affect organ perfusion in preterm infants is presented. This is important when trying to establish the optimal trigger threshold for RBCT in preterm infants, especially because the knowledge about the adaptive physiological responses to anaemia in very low birth weight infants and the effects of RBCT at various levels of anaemia is also inadequate. Further research into the physiological adaptive response to anaemia of varying degrees and to RBCT at different levels of anaemia in preterm infants of different gestational and post-natal ages is needed before we can conclusively guide the optimal timing and trigger thresholds for RBCT in preterm infants.
“…Similarly, Nelle et al [28] ( n = 33) also noticed a significant drop in heart rate (from 161 to 149 beats per min; p = 0.005) following RCBT [28]. Contrastingly Dani et al [29] ( n = 14) and Alkalay et al [30] ( n = 32) found no difference in heart rate following RBCT. However, it was subsequently demonstrated that heart rate correlates positively with the measured blood volume of preterm infants born at 24–32 weeks of gestation [31].…”
Section: Physiological Adaptive Response To Anaemia and Blood Transfumentioning
The current evidence regarding the indication, advantages and risks of red blood cell transfusion (RBCT) for preterm infants is discussed. This is an important area in Neonatology to be examined given that 90% of extremely low birth weight infants receive RBCT and many controversies remain regarding when to transfuse and the risks of RBCT. The various treatment thresholds and guidelines used are presented and we compare the short-term clinical benefits of liberal and restrictive RBCT in preterm infants; the majority of these are equivocal and sadly long-term outcome data is limited. The latest evidence on how anaemia and blood transfusion affect organ perfusion in preterm infants is presented. This is important when trying to establish the optimal trigger threshold for RBCT in preterm infants, especially because the knowledge about the adaptive physiological responses to anaemia in very low birth weight infants and the effects of RBCT at various levels of anaemia is also inadequate. Further research into the physiological adaptive response to anaemia of varying degrees and to RBCT at different levels of anaemia in preterm infants of different gestational and post-natal ages is needed before we can conclusively guide the optimal timing and trigger thresholds for RBCT in preterm infants.
“…This was highlighted by a panel of young adults with FASD at the Seventh International FASD Conference (2017), who stated that rather than describing FASD as a brain‐based disorder, it should be described as a “whole‐body disorder” (Himmelreich et al., ). This conference also prompted publication of a minireview, highlighting that even low–moderate alcohol exposure can program chronic disease in offspring, at least from animal studies (Sarman, ).…”
Prenatal alcohol exposure (PAE) results in well-characterized neurological, behavioral, and cognitive deficits in offspring. However, the effects on other health outcomes have not been comprehensively described. We used a systematic review methodology to survey published clinical and preclinical studies investigating a broad range of health outcomes in offspring with PAE. This study specifically reports on outcomes related to metabolism and body composition. The literature was systematically searched across 4 electronic databases (PubMed, CINAHL, Embase, and Web of Science), resulting in 3,230 articles following duplicate removal. Titles and abstracts were reviewed against specific inclusion/exclusion criteria, with 242 articles meeting the criteria for full-text assessment of eligibility. Articles with ineligible study type were removed (127) and articles added from reference lists (15) and an updated search closer to submission (9) for a total of 139 studies. Although 5 health domains were identified, here we focus on metabolism and body composition. Details of alcohol exposure, offspring demographics, and sample sizes were tabulated and quality of reporting assessed. Findings were summarized for body composition (percentage fat mass), physiological and molecular outcomes related to glucose metabolism, and outcomes related to lipid metabolism. There were 32 included studies (2 case-control, 1 prospective longitudinal cohort, and 29 preclinical). Studies had a range of alcohol exposures, both dosage and timing, although all clinical studies had heavy PAE and/or evidence of fetal alcohol syndrome in offspring. The preclinical studies provided evidence of glucose intolerance and/or insulin resistance; dyslipidemia and/ or hypercholesterolemia; and increased adiposity in offspring with PAE. Due to the paucity of clinical studies, we recommend further studies be conducted to obtain a complete assessment of long-term metabolic health outcomes in children and adults with PAE, particularly in those diagnosed with fetal alcohol spectrum disorder.
“…This review by Sarman provides paediatricians with new insights into the effects of prenatal alcohol exposure to help them communicate key messages about avoiding alcohol during pregnancy. The author looked at studies published since 2010, which showed that even low levels of prenatal alcohol exposure could cause adverse foetal effects on the brain and other organs . The review concluded that it is not currently possible to determine a safe period and level when alcohol consumption would not affect the foetus.…”
Section: Even Low Levels Of Early Foetal Alcohol Exposure May Cause Amentioning
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