Impacto del volumen de sangre extraído por flebotomía sobre el requerimiento transfusional en prematuros menores de 1500 g. Estudio cuasiexperimental / Impact of the volume of blood collected by phlebotomy on transfusion requirements in preterm infants with birth weight of less than 1500 g. A quasi-experimental study

Introducción. La anemia es una complicación para los recién nacidos de muy bajo peso al nacer, y los exámenes de laboratorio son un factor de riesgo preponderante. Más del 50 % recibe, al menos, una transfusión de glóbulos rojos. Estas se han asociado a mayor riesgo de infecciones, hemorragia intracraneal, enterocolitis necrotizante y displasia broncopulmonar. En 2012, se implementó, en el Hospital Italiano de Buenos Aires, una estrategia de menor volumen de extracción de sangre por flebotomía. El objetivo del presente estudio fue evaluar su asociación con el número detransfusiones.Métodos. Estudio cuasiexperimental del tipo antes/después. Se comparó el número de transfusiones entre dos grupos de prematuros de muy bajo peso con diferente volumen de extracción. Se evaluó la correlación entre el volumen extraído y el número de transfusiones estimando el coeficiente de Spearman. Para ajustar por confundidores, se realizó un modelo de regresión logística.Resultados. Se incluyeron en el estudio 178 pacientes con edad gestacional media de 29,4 semanas (desvío estándar: 2,7) y peso al nacer de 1145 gramos (875-1345). El perfil de la serie roja inicial fue similar entre ambos grupos. El número de transfusiones (p = 0,017) y el volumen transfundido (p = 0,048) disminuyeron significativamente. El coeficiente de correlación resultó de 0,83. En el análisis multivariado, volumen de extracción y peso al nacer se asociaron a un requerimiento mayor de 3 transfusiones.Conclusión. Un menor volumen de extracción de sangre en prematuros de muy bajo peso está asociado de manera independiente a menor requerimiento transfusional.

Introduction. Anemia is a complication in very low birth weight (VLBW) infants, and lab tests are a predominant risk factor. At least one red blood cell transfusion is given in more than 50 % of cases. Transfusions are associated with a higher risk for infections, intracranial hemorrhage, necrotizing enterocolitis, and bronchopulmonary dysplasia. In 2012, Hospital Italiano de Buenos Aires implemented a strategy to collect a lower blood volume by phlebotomy. The objective of this study was to assess its association with the number of transfusions.Methods. Before-and-after, quasi-experimental study. The number of transfusions was compared between two groups of VLBW preterm infants with different blood collection volumes. The correlation between the collection volume and the number of transfusions was assessed estimating Spearman's coefficient. A logistic regression model was used to adjust for confounders.Results. The study included 178 patients with a mean gestational age of 29.4 weeks (standard deviation: 2.7) and a birth weight of 1145 g (875-1345). The baseline red series profile was similar between both groups. The number of transfusions (p = 0.017) and the transfusion volume (p = 0.048) decreased significantly. The correlation coefficient was 0.83. In the multivariate analysis, collection volume and birth weight were associated with a requirement of more than three transfusions.Conclusion. A lower blood collection volume in VLBW preterm infants is independently associated with fewer transfusion requirements.

Anemia neonatal grave secundaria a transfusion feto-materna: a proposito de un caso / Severe neonatal anemia due to fetomaternal hemorrhage: an ilustrative case

La transfusión feto-materna es el paso de eritrocitos fetales a la circulación materna. Cuando es masiva, tiene una incidencia aproximada del 0,2-0,9 %. Generalmente, se desconoce el agente desencadenante, pero, en ocasiones, se pueden identificar factores de riesgo. En el embarazo, suele ser asintomática; el síntoma más frecuente es la disminución de los movimientos fetales (el 26 %) en relación con la anemia grave. Se diagnostica mediante la detección de hemoglobina fetal en la sangre materna (test de Kleihauer o citometría de flujo). Se presenta a un recién nacido con anemia crónica secundaria a la transfusión fetomaterna, que, después del tratamiento con transfusión de concentrado de hematíes, tuvo como complicación síntomas de sobrecarga de volumen y empeoramiento clínico. Tras la realización de una exanguinotransfusión, evolucionó favorablemente, sin secuelas.

Fetomaternal transfusion (FMT) is defined by the transfer of fetal blood into the maternal circulation. The incidence of massive FMT is estimated to be approximately 0.2-0.9 % of births. Although a number of etiologies have been associated with FMT, most causes remain unidentified and the pregnancy is usually asymptomatic. The most frequent symptom is the decrease in fetal movements (26 %) in relation to severe anemia. Several diagnostic modalities for FMT are described (Kleihauer stain, flow cytometry). We describe a case of a newborn with chronic anemia secondary to FMT who, after treatment with transfusions of red blood cells, presented volume overload and clinical worsening as a complication. In this case, our patient needed exchange transfusion for definitive improvement without disability.

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.

Aspects épidemiologiques et thérapeutiques de l'anémie néonatale au centre hospitalo-universitaire d'Angondje- Gabon

Introduction : l'anémie néonatale est une pathologie fréquemment rencontrée dans les services de néonatologie. Sa prévalence est mal définie dans la littérature en général, et en Afrique en particulier. Objectif : étudier les caractéristiques épidémiologiques et thérapeutiques de l'anémie néonatale au Centre Hospitalo-Universitaire d'Angondjé. Patients et méthodes : il s'agit d'une étude rétrospective qui s'est déroulée au Centre Hospitalo-Universitaire d'Angondjé, sur une période de 4 ans allant de 2012 à 2016. Tous les dossiers de nouveau-nés hospitalisés pendant cette période et ayant présenté une anémie (taux d'hémoglobine ˂13g/dl) ont été inclus. Résultat : 105 cas d'anémie néonatale avait été enregistré parmi les 658 hospitalisations soit une prévalence de 16%. Les nouveau-nés prématurés représentaient 64%. A l'admission, 45,7% de nouveau-nés présentaient d'emblée une anémie avec un taux moyen d'hémoglobine de 10,8g/dl et 54,3% étaient non anémiés à l'admission avec une hémoglobine moyenne de 15,2g/dl±2,5. L'infection néonatale (56,3%), l'anoxie périnatale (8,5%), la prématurité, les prélèvements répétés représentent les facteurs de risque associés à la survenue de l'anémie. La transfusion de globules rouges était la base thérapeutique dans 69,1% de cas. Le taux de décès lié à l'anémie était de 9,6%. Conclusion : l'anémie chez le nouveau-né est un facteur de risque de mortalité néonatale en Afrique, et dans le monde. La régression de ce trouble passe par la prévention

Safety of umbilical cord milking in very preterm neonates: a randomized controlled study

OBJECTIVE: To investigate the safety of umbilical cord milking on both the mother and neonate among very preterm deliveries of less than 33 weeks of gestation. METHODS: Pregnant women who were expected to deliver at between 24 0/7 and 32 6/7 weeks of gestation were randomized to either the umbilical cord milking or immediate cord clamping group. Maternal and neonatal data associated with delivery, in addition to neonatal morbidity and mortality data, were collected and analyzed. RESULTS: Of the 66 preterm deliveries included in the study, 34 were randomized into the milking and 32 into the clamping group. Differences between maternal pre- and post-partum hemoglobin levels were 1.35 g/dL in the milking and 1.58 g/dL in the clamping group (P=0.451). Neonatal Apgar scores at both 1 and 5 minutes, initial blood gas analysis results, body temperature at admission, need for early intubation, and maximum bilirubin levels were all similar between the 2 groups. However, neonatal hemoglobin levels at birth (15.79 vs. 14.69 g/dL; P<0.05) and at 24 hours of age (14.83 vs. 13.29 g/dL; P<0.05) were significantly higher in the milking group. Neonates in the clamping group required more blood transfusion (1.78 vs. 0.93; P=0.049), and a higher percentage of neonates in the clamping group required inotropic drugs (63% vs. 29%; P=0.007). The mortality rate was significantly lower in the milking group (6% vs. 28%; P=0.015). CONCLUSION: Umbilical cord milking can be a safe and beneficial procedure for both the mother and the neonate in deliveries of less than 33 weeks of gestation.

Micronutrient supplementation adherence and influence on the prevalences of anemia and iron, zinc and vitamin A deficiencies in preemies with a corrected age of six months

OBJECTIVE: To analyze adherence to the recommended iron, zinc and multivitamin supplementation guidelines for preemies, the factors associated with this adherence, and the influence of adherence on the occurrence of anemia and iron, zinc and vitamin A deficiencies. METHODS: This prospective cohort study followed 58 preemies born in 2014 until they reached six months corrected age. The preemies were followed at a referral secondary health service and represented 63.7% of the preterm infants born that year. Outcomes of interest included high or low adherence to iron, zinc and multivitamin supplementation guidelines; prevalence of anemia; and prevalences of iron, zinc, and vitamin A deficiencies. The prevalence ratios were calculated by Poisson regression. RESULTS: Thirty-eight (65.5%) preemies presented high adherence to micronutrient supplementation guidelines. At six months of corrected age, no preemie had vitamin A deficiency. The prevalences of anemia, iron deficiency and zinc deficiency were higher in the low-adherence group but also concerning in the high-adherence group. Preemies with low adherence to micronutrient supplementation guidelines were 2.5 times more likely to develop anemia and 3.1 times more likely to develop zinc deficiency. Low maternal education level increased the likelihood of nonadherence to all three supplements by 2.2 times. CONCLUSIONS: Low maternal education level was independently associated with low adherence to iron, zinc and vitamin A supplementation guidelines in preemies, which impacted the prevalences of anemia and iron and zinc deficiencies at six months of corrected age.

Factores maternos relacionados con la anemia en recién nacidos pretérminos. Hospital Dr. Verdi Cevallos Balda. Portoviejo. Ecuador. Abril septiembre 2015 / Maternal factors related to anemia in preterm infants. Hospital Dr. Verdi Cevallos Balda. Portoviejo. Ecuador. April september 2015

La anemia en los neonatos pretérrminos definida como la disminución de los glóbulos rojos, hemoglobina o del hematocrito relacionados a la edad gestacional, es una de las enfermedades más frecuentes a nivel mundial, por ello se ha realizado una investigación que relacione los factores de riesgos maternos que se involucran con la aparición de la anemia en prematuros, en el periodo de abril a septiembre 2015 en el Hospital Dr. Verdi Cevallos Balda. De tipo descriptivo, prospectivo de diseño no experimental con una muestra de 32 pacientes se obtuvo como resultado que el 56 por ciento de los pacientes correspondió al sexo masculino, el 72 por ciento se encontró entre las 32 a 37 semanas degestación, en el 75 por ciento de los casos se realizó un oportuno pinzamiento del cordón umbilical, la causa más común de anemia neonatal en estos pacientes fueron las hemorragias internas en el 25 por ciento de los casos seguido de las malformaciones de vasos umbilicales en el 22 por ciento de los casos las madres de los afectados eran en el 38 por ciento de los casos mujeres añosas y multiparas y el 25 por ciento de las madres tenían como antecedentes patológico placenta previa, se recomendó controles prenatales mensuales para prevenir dichas complicaciones, y la socialización del mismo.

Anemia in preterm infants is called as decreased red blood cells, hemoglobin or hematocrit related to gestational age to be one of the first most common diseases worldwide, especially those in developing countries as the ours has been chosen this topic for an investigation linking maternal risk factors that are involved with the development of neonatal anemia in prematures study in the period from April to September 2015in Dr. Verdi Cevallos Balda Hospital. Descriptive, prospective non experimental design with a sample of 32 patients resulting in 56 percent of patients corresponded to male, 72 percent was found between 32-37 weeks of gestation, 75 percent cases, an oppor pinzaminto umbilical cord was performed, the most common cause of neonatal anemia in these patients were internal bleeding in 25 percent of cases followed by umbilical vessels malformations in 22 percent of cases mothers were affected in 38 percent of cases añosas and multiparous women and 25 percent of mothers had pathological history as placenta previa, monthly prenatal checkups are recommended to prevent nutritional deficiencies and complications, proper management as indicated by the regulations msp and socialization of it.

Safety of cesarean delivery through placental incision in patients with anterior placenta previa

OBJECTIVE: To demonstrate the safety of fetal delivery through placental incision in a placenta previa pregnancy. METHODS: We examined the medical records of 80 women with singleton pregnancy diagnosed with placenta previa who underwent cesarean section between May 2010 and May 2015 at the Department of Obstetrics and Gynecology, Chungbuk National University Hospital. Among the women with placenta previa, those who did not have the placenta in the uterine incision site gave birth via conventional uterine incision, while those with anterior placenta previa or had placenta attached to the uterine incision site gave birth via uterine incision plus placental incision. We compared the postoperative hemoglobin level and duration of hospital stay for the mother and newborn of the two groups. RESULTS: There was no difference between the placental incision group and non-incision group in terms of preoperative and postoperative hemoglobin change, the amount of blood transfusions required by the mother, newborns with 1-min or 5-min Apgar scores below 7 points or showing signs of acidosis on umbilical cord blood gas analysis result of pH below 7.20. Moreover, neonatal hemoglobin levels did not differ between the two groups. CONCLUSION: Fetal delivery through placental incision during cesarean section for placenta previa pregnancy does not negatively influence the prognosis of the mother or the newborn, and therefore, is considered a safe surgical technique.

Massive Fetomaternal Hemorrhage Diagnosed with High-performance Liquid Chromatography / 임상소아혈액종양

Massive fetomaternal hemorrhage (FMH) is a major cause of unexplained fetal death and neonatal anemia. FMH can be diagnosed using the Kleihauer-Betke test or flow cytometry by identifying the presence of fetal red cells in the maternal blood. However, timely diagnosis is a challenge because many hospitals lack the equipment needed to perform such tests. The authors experienced a case of FMH diagnosed via high-performance liquid chromatography (HPLC) which is generally used in measuring glycated hemoglobin (HbA1c) in a patient with unexplained neonatal anemia. A girl aged 2 days was transferred to our hospital for showing pallor and a hemoglobin level of 5.0 g/dL. HPLC revealed 3% fetal hemoglobin (HbF) in the maternal blood. HPLC is a quick test for quantifying HbF that is readily available in many hospitals and could serve as a promising alternative for diagnosing FMH.

Massive Fetomaternal Hemorrhage Diagnosed with High-performance Liquid Chromatography / 임상소아혈액종양

Massive fetomaternal hemorrhage (FMH) is a major cause of unexplained fetal death and neonatal anemia. FMH can be diagnosed using the Kleihauer-Betke test or flow cytometry by identifying the presence of fetal red cells in the maternal blood. However, timely diagnosis is a challenge because many hospitals lack the equipment needed to perform such tests. The authors experienced a case of FMH diagnosed via high-performance liquid chromatography (HPLC) which is generally used in measuring glycated hemoglobin (HbA1c) in a patient with unexplained neonatal anemia. A girl aged 2 days was transferred to our hospital for showing pallor and a hemoglobin level of 5.0 g/dL. HPLC revealed 3% fetal hemoglobin (HbF) in the maternal blood. HPLC is a quick test for quantifying HbF that is readily available in many hospitals and could serve as a promising alternative for diagnosing FMH.

Enfermedad de orina a jarabe de arce: presentación de caso clínico / Maple Syrup Urine Disease: A case report

Antecedentes: La enfermedad de orina olor a jarabe de arce (EOJA) es un error congénito del metabolismo de herencia autosómica recesiva, causado por la actividad defectuosa del com- plejo enzimático deshidrogenasa de α -cetoáci- dos, ocasionando que los aminoácidos de cadena ramificada; valina, leucina e isoleucina no puedan catabolizarse completamente. Se trata de lactante menor, tres meses de edad, con antecedente de vómitos frecuentes y rechazo a la alimentación desde la primera semana de vida, tratado por alergia a la proteí- na de la leche de vaca y reflujo gastroesofágico grado IV, con varios cambios de formula en su alimentación. Trasladado al Instituto Hondure- ño del Seguro Social, Hospital Regional del Norte (IHSS-HRN) con historia de cinco días de tos, fiebre y aproximadamente nueve horas de dificultad respiratoria. Tres horas más tarde presenta convulsiones tónicas y choque, por lo que se trasladado a sala de cuidados intensivos pediátricos, acoplándose a ventilador mecáni- co. Laboratorialmente: acidosis metabólica persistente que se logró controlar a las 48 horas, Anión Gap: 17, cetonuria, IRM con impor- tante atrofia cortical. Se encontró elevación de los metabolitos de aminoácidos de cadena ramificada; 2-OH isovalerico, 2- OH isocaproico, 2-ceto-3 methylvalerico, 2 cetoisocaproico consistentes con EOJA y elevación del ácido láctico y alfa cetoglutarato; que podrían indicar defectos en la subunidad E3 de la enzima deshidrogenasa. Conclusiones: Los errores innatos del metabolismo son más frecuente- mente diagnosticados cada día, y deben sospe- charse en los niños con vómitos frecuentes...(AU)

Transfusiones de glóbulos rojos en recién nacidos de muy bajo peso de nacimiento / Red blood cell transfusions in very low birth weight newborns

Introducción: Se ha reportado que el 80% de los recién nacidos de muy bajo peso de nacimiento (RNMBPN) es receptor de transfusiones de glóbulos rojos desplasmatizados (trGRD) y en el 90 por ciento de ellos, la indicación de transfusión es la reposición de sangre extraída. La acción en salud que mayor impacto ha tenido sobre el descenso del número de transfusiones, es la existencia de guías para la práctica transfusional. El objetivo de este trabajo es describir las características de los RNMBPN receptores de trGRD. Pacientes y Método: Estudio transversal descriptivo, que incluyó las fichas clínicas de todos los RNMBPN, mayores de 72 h de vida, egresados de Neonatología, Hospital Base Valdivia, entre el año 2005 y 2006. Se evaluaron el peso de nacimiento, edad gestacional, surfactante pulmonar, membrana hialina, ventilación mecánica, displasia broncopulmonar, sepsis y transfusiones de GRD. Se utilizó la Guía para la Práctica Transfusional de GRD en neonatos del Centro Base. Resultados: Fueron evaluados 93 neonatos, siendo transfundidos 62 de 93 neonatos (66,7 por ciento recibiendo 2,1 +/- 0,9 trGRD, la exposición a donantes diferentes fue de 2,1 +/- 0,9. Los RNMBPN susceptible de ser receptor de trGRD fueron de edad gestacional < 30 sem, peso inferior a 1.250 g, con falla respiratoria, ventilación mecánica y sepsis. Conclusión: Los porcentajes observados de RNMBPN transfundidos, la media de trGRD y de exposición a diferentes donantes, podrían ser atribuidos a la existencia de guías para la práctica transfusional neonatal y a un equipo de neonatólogos altamente sensibilizado.

Introduction: It has been reported that 80 percent of very low birth weight infants (VLBWI) are receiving packed red blood cell transfusions (PRBCtr), and in 90 percent of cases, the indication is the replacement of the blood collected. The existence of guidelines for transfusion practices has had a great impact on the decline in the number of transfusions. The aim of this paper is to describe the characteristics of VLBW infants who are packed red blood cell transfusion receptors. Patients and Methods: This is a descriptive cross-sectional study, which included the medical records of all VLBW newborns older than 72 hours, released from the Neonatology department of the Hospital Valdivia Base, between 2005 and 2006. Birth weight, gestational age, pulmonary surfactant, hyaline membrane, mechanical ventilation, bronchopulmonary dysplasia, sepsis and packed red blood cell transfusions were evaluated. Guidelines for packed red cell transfusions were used at the Hospital. Results: 93 newborns were evaluated and 62 of them were transfused (66.7 percent); they received 2.1 +/- 0.9 PRBC transfusion and the exposure to different donors was 2.1 +/- 0.9. The VLBW infants susceptible to be PRBCtr receptor were those younger than 30 weeks' gestational age, weighing less than 1,250 g and with respiratory failure, mechanical ventilation and sepsis. Conclusion: The observed percentages of transfused infants with very low birth weight, median PRBCtr and exposure to different donors can be attributed to the existence of guidelines for neonatal transfusion practices and a team of highly experienced neonatologists.

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

Clinical study of iron protein succinylate oral solution for preventing and treating anemia of prematurity / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy and safety of iron protein succinylate (IPS) oral solution in preventing and treating anemia of prematurity (AOP).</p><p><b>METHODS</b>Sixty premature infants less than 35 weeks of gestation were randomly divided into IPS (n=30) and polysaccharide iron complex (PIC) groups(n=30). Treatment began at two weeks after birth. The infants received IPS or PIC in addition to recombinant human erythropoietin. On days 14, 28, 42, and 60 after treatment, hemoglobin (Hb), red blood cell count(RBC), hematocrit (HCT), percentage of reticulocytes, serum iron, and serum ferritin were determined. Liver and renal functions were evaluated before and after treatment.</p><p><b>RESULTS</b>There were significant differences in the changing trends of RBC and HCT between the two groups (P<0.05). In the IPS group, RBC and HCT gradually decreased after birth, but began to rise gradually on days 28 and 42 of treatment; in the PIC group, RBC and HCT kept decreasing from birth to day 60 of treatment. On day 60 of treatment, the IPS group had significantly higher levels of Hb, RBC, HCT, serum iron, and serum ferritin than the PIC group (P<0.05). No notable adverse events occurred in either group.</p><p><b>CONCLUSIONS</b>IPS oral solution has good efficacy and tolerability in preventing and treating AOP.</p>

Risk Factors of Transfusion in Anemia of Very Low Birth Weight Infants

PURPOSE: Anemia of prematurity is frequent in preterm infants, for which red blood cell (RBC) transfusion remains the treatment of choice. In this study, we attempted to evaluate the characteristics and risk factors of anemia of prematurity, and suggest ways to reduce anemia and the need for multiple transfusions. MATERIALS AND METHODS: Preterm infants weighing less than 1500 g (May 2008-May 2009) were divided into two groups depending on whether they received RBC transfusions (transfusion group and non transfusion group). Hemoglobin (Hb) concentration, phlebotomy blood loss, and the amount of RBC transfusion were analyzed. Risk factors of anemia and RBC transfusions were analyzed. RESULTS: Fifty infants that survived were enrolled in the present study: 39 in the transfusion group and 11 in the non transfusion group. Hb concentrations gradually decreased by eight weeks. In the transfusion group, gestational age and birth weight were smaller, bronchopulmonary dysplasia and sepsis were more frequent, full feeding was delayed, parenteral nutrition and days spent in the hospital were prolonged, and phlebotomy blood loss was greater than that in the non transfusion group. CONCLUSION: Anemia of prematurity was correlated with increased laboratory blood loss, decreased birth weight, prolonged parenteral nutrition, and delayed body weight gain. Accordingly, reducing laboratory phlebotomy loss and parenteral nutrition, as well as improving body weight gain, may be beneficial to infants with anemia of prematurity.

Anemia de células falciformes: Guía de manejo pediátrico / Sickle cell disease: pediatric management guide

La anemia de células falciformes o drepanocítica es una enfermedad común en la edad pediátrica, con alta mortalidad en menores de 5 años de edad. Cuando un niño hereda esta condición de sus padres quienes son portadores, los glóbulos rojos sufren un cambio de forma o “falciformación”, alterando el flujo de sangre y provocando enfermedad, dolor y daño de órganos. Es necesario el despistaje universal a todos los recién nacidos, para identificar los afectados e iniciar tempranamente su cuidado y educación a los padres para prevenir ytratar las complicaciones, permitiéndoles tener una mejor calidad de vida. Se presentan unas guías y opciones terapéuticas para laprevención y el manejo de las complicaciones

Sickle cell disease (SCD) is a common condition in childhood with a high mortality rate, especially under 5 years of age. When children inherit SCD from their carrier parents, the red blood cells form an abnormal sickled shape. As a result, blood does not flow well, causingdisease, pain and organ damage. Universal newborn screening is necessary to identify and treat early those affected babies, thus preventing complications and allowing them to have a healthier life. Here is a set of guidelines and treatment options to prevent and manage sickle cell related complications

Prevalencia de anemia en lactantes menores de 6 meses asistidos en un centro de atención primaria de la ciudad de La Plata / Prevalence of anemia in infants under the age of 6 months being treated at a primary care setting in the city of La Plata, Argentina

La anemia es un problema de salud pública que afecta particularmente a los menores de 2 años, con graves consecuencias en el desarrollo psicomotor e intelectual de los niñosy en las capacidades productivas en la adultez.Objetivo. Estudiar la prevalencia de anemia, sus variaciones y los posibles factores asociados en niños menores de 6 meses. Población y métodos. Se realizó un estudio descriptivo de corte transversal, revisando los registros de controles de salud de 363 niños con edades comprendidas entre 4 y 5 meses de edad completos, asistidos durante 2007-2010. Se analizó la asociación entre anemia (hemoglobina menor10,3 g/dl) y alimentación (amamantamiento exclusivo o alimentación complementaria), tipo de parto y sexo. Se compararon las medias de peso al nacer y la puntuación z de peso para edad, talla para edad y peso para talla, en niños anémicos contra no anémicos.Resultados. El 28,9 por ciento (105/363) de los niños presentaron anemia y la prevalencia fue significativamente mayor en los varones (38,3 por ciento contra 20,9 por ciento; p= 0,000). No hubo diferencias significativas según el tipo de alimentación y la forma determinación del parto. La media de peso al nacer y de puntuación z de peso para edad, talla para edad y peso para talla fue significativamente menor en los anémicos contra los no anémicos.Se encontró una disminución significativa de la anemia (de 37,8 por ciento en 2007 a 20,3 por ciento en 2010 en el período estudiado, p= ,012). Conclusión. La prevalencia de anemia fue de 28,9 por ciento y descendió significativamente entre el 2007 y 2010. Fue mayor en varones, en niños nacidos con menor peso y con menores índices antropométricos. Nuestros resultados, aun cuando tienen carácter local, reflejan el alto riesgo nutricional de la población menor de 6 meses.

Perinatal risk factors for neonatal asphyxia in Vali-e-Asr hospital, Tehran-Iran

Asphyxia is a medical condition in which placental or pulmonary gas exchange is impaired or they cease all together, typically producing a combination of progressive hypoxemia and hypercapnea. In addition to regional differences in its etiology; it is important to know its risk factors. This is a case-control study, all neonates born from May 2002 to September 2005 in Vali-e-Asr Hospital were studied. 9488 newborns were born of which 6091 of the live patients were hospitalized in NICU. 546 newborns were studied as case and control group. 260 neonates [48%] were female and 286 neonates [52%] were male. Among the neonates who were admitted, 182 of them were diagnosed with asphyxia and twice of them [364 newborns] were selected as a control group. The variables consist of; gestational age, type of delivery, birth weight, prenatal care, pregnancy and peripartum complications and neonatal disorders. Our studies showed that 35 [19.2%] patients had mild asphyxia, 107 [58.8%] had moderate asphyxia and 40 [22%] were diagnosed as severe asphyxia. Mean maternal age was 34.23 +/- 4.29yr; [range: 23-38 yr]; and mean of parity was 2 +/- 1.2; [range: 1-8]. Risk factors in our study included emergent Caesarian Section, preterm labor [<37w], low birth weight [<2500g], 5 minute Apgar [less than 6], need for resuscitation, nuchal cord, impaired Biophysical Profile, neonatal anemia, and maternal infertility. All risk factors listed above play a role in asphyxia. The majority of these factors are avoidable by means of good perinatal care

Anemia muy precoz del prematuro con peso ≤ 1 500 g: prevalencia y factores asociados / Very early anemia in premature weighing ≤ 1 500 g: prevalence and associated factors

INTRODUCCIÓN. En el Hospital Ginecoobstétrico Docente Ramón González Coro no se ha estudiado la prevalencia de la anemia muy precoz de la prematuridad y los factores asociados a su aparición. Se decidió realizar esta investigación para dar respuesta a esta interrogante y proporcionar bases a las autoridades administrativas para el trazado de estrategias preventivas más eficaces, que reduzcan esta complicación y sus consecuencias.MÉTODOS. Se realizó un estudio prospectivo, de corte transversal, donde se incluyeron todos los recién nacidos (RN) ≤ de 1 500 g nacidos antes de las 37 semanas y atendidos en el servicio de neonatología del hospital durante el año 2008. El universo de estudio estuvo constituido por 25 neonatos. Se determinó en cada uno la presencia o no de anemia muy precoz. Se determinó la prevalencia de esta enfermedad y los factores maternos, perinatales y posnatales asociados.RESULTADOS. Presentó anemia muy precoz el 52 por ciento de los neonatos (13/25). La hemoglobina materna baja no se asoció a la anemia muy precoz (RP 0,62; IC 95 por ciento 0,21-1,80). Ninguna variable perinatal se asoció a la anemia muy precoz, aunque se encontró que la prevalencia de esta enfermedad disminuye al aumentar la edad gestacional al nacer (tendencia lineal: X2 4,33; gl 1; p 0,037). Los RN con alguna morbilidad grave tuvieron 2,44 veces más probabilidad de presentar anemia muy precoz (RP 2,44; IC 95 por ciento 1,01-5,87). La prevalencia de la anemia muy precoz se incrementó al aumentar los mililitros por kilogramo de peso de sangre extraída (tendencia lineal: X2 7,6195; gl 1; p 0,0058). Los RN con extracciones entre 5 y 10 mL/kg y > 10 mL/kg tuvieron 5,3 y 4,5 veces más probabilidad de presentar anemia (RP 5,33; IC 95 por ciento 1,4739-19,2988 y RP4,5 ; IC 95 por ciento 1,1254-7,9930, respectivamente).CONCLUSIONES. Un poco más de la mitad de los casos presentaron anemia muy precoz y los factores independientes asociados...

INTRODUCTION. At Ramón González Coro Gynecology and Obstetrics Hospital the prevalence of the very early anemia of prematurity and factors associated with its appearance has not been studied. Present research was conducted to answer this question mark and to provide the bases to managerial authorities for the design of more effectiveness preventive strategies to reduce this complication and its consequences. METHODS. A cross-sectional and retrospective study was conducted including all newborn (NB) weighing ≤ 1 500 g delivered before the 37 weeks and seen in the Neonatology Service of this hospital for 2008. Study sample included 25 neonates determining in each the presence or not of a very early anemia, as well as the prevalence of this disease and the associated maternal, perinatal and postnatal factors. RESULTS. The 52 percent of neonates (13/25) had a very early anemia. A low maternal hemoglobin was not associated with this type of anemia (RP 0,62; 95 percent CI 0,21-1,80). No perinatal variable was associated with the above anemia, although we found that the prevalence of this disease decrease according the increase in gestational age at birth (linear trend: X² 4,33; gl 1; p 0,037). The newborns with any severe morbidity had 2,44 times more chance to have a very early anemia (RP 2,44; 95 percent CI 1,01-5,87). The prevalence of this type of anemia increased according the increase of milliliters by kg/w of blood extracted (linear trend: X² 7,6195; gl 1; p 0,0058). The newborn with blood extractions between 5 and 10 mL/kg and > 10 mL/kg had 5,3 and 4,5 times more chance to have anemia (R 5,33; 95 percent CI 1,4739-19,2988 and RP4,5; 95 percent CI 1,1254-17,9930, respectively). CONCLUSIONS. More or less the half of cases had a very early anemia and the independent factors associated with its appearance were the presence of a severe disease and to total volume of blood extracted