A randomised control trial comparing the efficacy of cord milking over the delayed cord clamping on serum ferritin level in preterm neonates at 6 weeks of age

Background: Perinatal iron deficiency has received little attention in the past. Umbilical cord milking is a type of placental transfusion, they serve to potentially enhance neonatal blood volume and consequently the iron stores after birth. Among the neonates, the preterm infants are sick and vulnerable babies who are already deprived of iron stores. The aim of this study was to evaluate the effect of cord milking on ferritin values amongst preterm neonates.Methods: This is a hospital based randomized control trial which included the babies born at 29-36 weeks of gestation. The babies were randomized to two intervention groups; cord milking and delayed cord clamping group. Detailed clinical history taken, including details of labour and clinical examination. Blood samples were analysed for ferritin as required at 6 weeks of post-natal age.Results: Neonates under cord milking group had higher ferritin values (249.04'21.93 ng/mL) as compared to those neonates under delayed cord clamping group (179.66'32.94 ng/mL) and this was statistically very significant (p= <0.001).Conclusions: In preterm neonates, umbilical cord milking results in improved iron status as shown by higher ferritin values at 6 weeks of life. UCM can be a used as placental transfusion strategy in preterm neonates for improving iron status and preventing anemia of prematurity.

Anemia severa secundaria a excesiva extracción sanguínea en recién nacidos: un llamado de atención a los neonatólogos / Severe severe anemia to excessive blood extraction in recent Born: a call for attention to neonatologists

Contexto: Los exámenes de laboratorio son un complemento de interés como ayuda diagnóstica, tienen gran valor en las unidades de cuidados intensivos, especialmente en el área neonatal en donde los recién nacidos carecen de síntomas específicos para valorar determinadas patologías, el problema radica en que esta práctica se ha hecho rutinaria y excesiva teniendo como principal complicación la anemia. Propósito: Este estudio tiene como objetivo principal evaluar las complicaciones que se presentan debido a las repetidas extracciones sanguíneas a las que son sometidos los neonatos durante su estancia hospitalaria. Métodos: Se trata de un estudio observacional, analítico, descriptivo, prospectivo de corte longitudinal, se utilizó un formato de recolección de datos previamente validado, en donde se registraron a 220 neonatos hospitalizados en el área de neonatología del Hospital Luz Elena Arismendi que cumplían con los criterios de inclusión. Resultados: Se analizaron los datos de 220 recién nacidos, de los cuales 50% fueron a término y el otro 50% pretérmino, de ellos el 65,83% correspondió al sexo masculino y 34,17% al femenino, la principal complicación de las extracciones múltiples fue la anemia, que estuvo presente en el 46,36% de la población.Para el volumen de sangre extraída se observó que a los 5 días de vida el promedio de sangre extraído fue de 12,60 ml, volumen excesivo si se toma en cuenta la volemia aproximada de un recién nacido. Conclusiones: En el 46,36% de los neonatos se extrajo más del 10% de la volemia a los 5 días de vida, lo que aumento en 21,71 veces la probabilidad de presentar anemia iatrogénica, causando transfusiones en el 69,61% de estos pacientes de los cuales el 58,23% tenían menos de 10 días de vida al momento de la transfusión, además el 77,3% de los recién nacidos hospitalizados por más de 15 días presentaron 24,22 veces más probabilidad de desarrollar este tipo de anemia.

Context: Laboratory tests are a complement of interest as a diagnostic aid, they have great value in intensive care units, especially in the neonatal area where newborns lack specific symptoms to assess certain pathologies, the problem is that this practice has become a routine and excessive, with anemia as the main complication. Purpose: The main objective of this study is to evaluate the complications that occur due to the repeated blood extractions to which neonates are subjected during their hospital stay. Methods: This was an observational, analytical, descriptive, prospective, longitudinal study. A previously validated data collection format was used, where 220 neonates hospitalized in the neonatal area of the Luz Elena Arismendi Hospital were registered according to the inclusion criteria. Results: Data from 220 newborns were analyzed, of which 50% were full-term and the other 50% were preterm, 65.83% were male and 34.17% were female, the main complication of the multiple extractions was anemia, which was present in 46.36% of the population. Was observed that at 5 days of life the averages of blood extracted was 12.60 ml. Conclusions: In 46.36% of the neonates, more than 10% of the blood volume was extracted at 5 days of age, which increased the probability of presenting iatrogenic anemia by 21.71 times, causing transfusions in 69.61% of these patients of whom 58.23% had less than 10 days of life at the time of transfusion, in addition 77.3% of newborns hospitalized for more than 15 days were 24.22 times more likely to develop this type of anemia.

Analysis of characteristics of blood loss for laboratory test for 246 cases of critically ill premature infants / 国际儿科学杂志

Objective To analyze the characteristics of blood loss for laboratory test of critically ill premature infants,and to seek feasible measures to reduce the blood loss.Methods Two hundred and forty-six cases of critically ill premature infants admitted to the neonatal intensive care unit from April 2012 to April 2013 were analyzed the blood loss for test during the hospitalization and the clinical features of blood loss with different gestational age,different weight within the first four weeks after admission.Then the application of blood loss according to test category was described.The blood volume demanded in theory was determined by the formula B =5 (∑ s + 0.1),then calculated the phlebotomy overdraw on the basis of the practical blood loss and analyzed the characteristics of overdraw per patients per day in first two weeks after admission.Results Among 246 patients,The median blood loss figure was 25.57 ml for each infants with the range between 7.10 ml ～ 119.20 ml,and the blood loss concentrated in first four weeks,which showed a decreasing trend with time.There was a statistically significant difference(P ＜0.05)that the smaller gestational age,the lower birth weight,the more daily blood loss per patient per day in first two weeks,but no significant differences(P ＞ 0.05) between the third and fourth week.The largest proportion of the blood samples was used for clinical chemical tests(31.49％),followed by blood gas analysis (19.03％),immunoassays (12.69％),blood cultures (12.63％),hematology (12.28％).The practical blood loss was about twice times of blood volume demanded for tests in theory,which the median was 7.8 times to the latter(25.57 ml vs 3.26 ml).It showed statistically significant difference(P ＜0.05) between blood overdraw per patients per day in the first week and the second week.Compared with different gestational age and birth weight,the difference of overdraw was also statistically significant(P ＜0.05).According to test category,blood culture was the most significant samples of phlebotomy overdraw,followed by biochemical,other,blood gas analysis,the percentage was 76％,64％,45％ and 41％ respectively.Conclusion The blood loss for laboratory test and the phenomenon of blood waste is serious in critically ill preterm infants.The smaller the gestational age is,the lower the weight is,the amount of blood loss and phlebotomy overdraw are more significantly.Biochemical and blood gas analysis are the main items of blood loss.

Eficacia y seguridad de la eritropoyetina en la anemia de la prematuridad / Efficacy and safety of erythropoietin for anemia of prematurity

Introducción: la eritropoyetina alfa recombinante forma parte del tratamiento de la anemia de la prematuridad. En Cuba su uso ha sido limitado y controvertido en cuanto a esquema y dosis empleada. Métodos: ensayo clínico prospectivo, multicéntrico, no aleatorizado, de eficacia y seguridad de eritropoyetina en la disminución de transfusiones en el recién nacido pretérmino de muy bajo peso. Se incluyeron 72 neonatos con edad gestacional menor de 34 semanas posmenstruales, y peso al nacer menor o igual a 1 500 g, con más de 7 días posnatales e ingesta de 50 mL/kg/día. Resultados: todos recibieron eritropoyetina 300 U/kg, subcutánea, 3 veces/semana, hasta las 40 semanas de edad gestacional y suplemento de hierro y vitaminas. La eritropoyetina fue muy segura, solo se notificó con relación posible una retinopatía de la prematuridad, ligera y recuperada. Conclusiones: se transfundieron 7 pacientes (9,7 por ciento) en el curso del estudio. El uso tardío de eritropoyetina en el pretérmino de muy bajo peso confirma su eficacia y seguridad

Introduction: recombinant alpha erythropoietin is part of the treatment for anemia of prematurity. The use of this one in Cuba has been restricted and controversial as to schedule and dose. Methods: prospective, non-randomized multicenter assay on the safety and efficacy of erythropoietin in the reduction of blood transfusion in very-low-weight preterm newborn. Seventy two neonates with gestational age under 34 post-menstruation weeks, weighing equal or less than 1 500 g, over 7 days of life after birth and fed on 50 mL/kg/day were included in the study. Results: all of them received 300 U/kg erythropoietin by subcutaneous administration three times a week up to reaching 40 weeks of gestational age and an iron and vitamin supplement. Erythropoietin is very safe; it was just possibly related to slight retinopathy of prematurity, but overcome. Conclusions: seven patients were transfused (9.7 percent ) in the course of study. The late use of erythropoietin in very-low-weight preterm child confirms its efficacy and safety

Therapeutic effects of erythropoietin and different doses of vitamin E on the prevention of anemia in premature children / 国际儿科学杂志

Objective To research the therapeutic effect of vitamin E in prevention and treatment of anemia in premature children.Methods We investigated 90 cases of premature children admitted to the neonatal ward of our hospital from December 2010 to December 2011.According to hospital successively order these premature were randomly divided into control group (Group A),high-dose group (Group B),low-dose group (Group A).Group A including 30 cases,subcutaneous injection of erythropoietin(EPO) from the 7th days after admission,750IU/kg weekly for 3 times,for 4 weeks.At the same time,plus iron 6mg/(kg·d).On the basis of the above-mentioned control treatment,oral administration of different doses of vitamin E was in the treatment group,for 4 weeks.Group B including 30 cases was given vitamin E 15mg/(kg·d).Group C including 30 cases was given vitamin E 2.5mg/(kg· d).The changes of each group during the treatment in hematocrit (Hct),hemoglobin(Hb),red blood cell(RBC),reticulocyte(Ret) and the changes of serum concentrations of vitamin E before and after treatment were observed.Results Hct,Hb,RBC,Ret in group B,group C patients were both improved.The improvement of the indicators was better than that of group A (P ＜ 0.05).There was no significant difference between the improvement of each index of Group B and Group C(P ＞ 0.05).Serum concentrations of vitamin E after treatment in group B and group C patients were significantly higher and the difference was statistically significant(P ＜ 0.05).Serum concentration of vitamin E in group A didn't increase obviously.Conclusion Additional small doses of VitE should be given during EPO prevention of anemia in premature children.

Prevención de anemia en prematuros: transfusiones con eritropoyetina: Hospital de San José, 2006-2008 / Erythropoietin to prevent the anemia of prematurity: San José Hospital, 2006-2008

La terapia con eritropoyetina todavía no ha sido bien definida y su uso rutinario varía de acuerdo con el criterio de cada unidad neonatal. En el Hospital de San José la prevención de la anemia del prematuro ha ido cambiando con el tiempo. Objetivo: determinar la frecuencia de transfusiones según el tratamiento administrado a los recién nacidos pretérmino en la unidad de cuidado intermedio del Hospital de San José en el período 2006-2008. Metodología: se realizó un estudio observacional, descriptivo y longitudinal. Se revisaron 115 historias clínicas, de las cuales se obtuvieron 34 pacientes que cumplieron con los criterios de inclusión. Resultados: de los pacientes a quienes se les administró eritropoyetina 4,76% necesitaron transfusión y de los que no la recibieron 46,1% requirieron por lo menos una. Entre aquellos con edad gestacional corregida menor o igual a 30 semanas que recibieron eritropoyetina 50% no requirieron TR, y sin el uso de ésta 50% fueron transfundidos. Con edad gestacional mayor a 30 semanas y empleo de eritropoyetina, el 92,3% no requirieron TR y sin su uso el 71,3% sí. Conclusión: se puede pensar que el uso de eritropoyetina disminuye la necesidad de TR de glóbulos rojos.

Erythropoietin therapy has not yet been well defined and its use varies according to individual neonatal care unit protocols.Prevention of the anemia of prematurity at the San José Hospital has changed over time. Objective: to determine thefrequency of transfusion therapy related to the treatment administered to preterm infants at the Intermediate Care Unit at the San José Hospital between 2006 and 2008. Methodology: a longitudinal descriptive observational study was conducted in 34 patients satisfying the inclusion criteria, selected from 115 clinical records reviewed. Results: of patients who received erythropoietin 4.76% were transfused and of those who did not 46.1% required at least one transfusion. In those with a corrected gestational age = to 30 weeks who received erythropoietin, 50% did not require a transfusion, and of those who did not 50% were transfused. Those newborns with gestational age greater than 30 weeks and had received erythropoietin, 92.3% did not need to be transfused and of those who did not, 71.3% were transfused. Conclusion: it can be concluded that erythropoietin therapy reduces the need of red blood cells transfusion.

Prophylactic Treatment of Anemia of Prematurity with Recombinant Human Erythropoietin and High Doses of Iron

PURPOSE: We conducted randomized study to determine whether high doses (6mg/kg/ day) of iron would exert a more supplemental effect than low doses (3mg/kg/day), and which regimen of recombinant human erythropoietin (rHuEPO) and iron would be more beneficial in the prophylactic treatment of anemia of prematurity. METHODS: We randomly assigned 38 sick premature infants who were more likely than symptom-free premature infants requiring erythrocyte transfusions for infants with anemia of prematurity to receive rHuEPO, 100unit/kg, tiw, subcutaneously, plus iron, 3mg/kg/day, po, daily from the second day of life (group 1), 100unit/kg and 6mg/kg/ day (group 2), 200unit/kg and 3mg/kg/day (group 3), and 200unit/kg and 6mg/kg/day (group 4), respectively. RESULTS: There were no significant differences of hemoglobin levels and iron balances during treatment among all 4 groups. The rates of increase in reticulocyte counts were greater in group 4 and group 2 compared with group 3 and group 1, respectively, though these rates were statistically not significant. The blood volume differences (volume of phlebotomies-volume of transfusions) during treatment were higher in group 4 compared with group 1 (p<0.05). CONCLUSIONS: High doses of iron may be more effective in rapidly increasing reticulocyte counts, and 200unit/kg, tiw of rHuEPO plus 6mg/kg/day of iron is more beneficial in reducing the need for blood transfusions than any other regimen. Therefore the prophylactic treatment of anemia of prematurity and acute blood loss from frequent blood sampling in risky premature infants with rHuEPO, 200unit/kg, tiw, subcutaneously, plus iron 6mg/kg/day, po, daily from the second day of life is effective in reducing the number of blood transfusions. Additional controlled trials utilizing high doses of iron with rHuEPO and larger numbers of patients are justified.

Effect of Recombinant Human Erythropoietin on the Anemia of Premature Infants

PURPOSE: To determine whether the prophylactic treatment with recombinant human erythropoietin(rHuEPO) for the anemia of prematurity would reduce the need for blood transfusions. METHODS: We randomly assigned 17 premature infants to the rHuEPO group and the control group. For the rHuEPO group (n=9, birth weight=1210+/-156 g, gestational age=31.7+/-1.9 wk), rHuEPO (400 U/kg) was given three times a week for 4 weeks, plus iron (8 mg/kg/day) and vitamin E (25 IU/day). The same amount of vitamin E was only given for the control group (n=8, birth weight=1266+/-204 g, gestational age=30.0+/-1.9 wk). RESULTS: Reticulocyte counts and hematocrit values were higher in the rHuEPO group than the control group at the 4 week of study (10.0+/-1.5 % vs. 5.5+/-2.1 % : p<0.05 and 25.6+/-4.0 % vs.31.0+/-1.5 % : p<0.05). Also, hemoglobin F were higher in the rHuEPO group than the control group at the 4 week of study (76.2+/-8.1 % vs.27.2+/-33.3 % : p<0.05). The rHuEPO treatment group required fewer blood transfusions during the study period (1.25 vs. 0.11 : p<0.05). And the complications such as leukopenia, thrombocytosis and infection did not develop during the study period. There was no evidence of iron deficiency state in the both groups. CONCLUSIONS: The rHuEPO treatment, in combination with iron supplementation, prevented the anemia of prematurity and reduced the need for blood transfusion in the premature infants.