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Initial hematocrit values after birth and peri/intraventricular hemorrhage in extremely low birth weight infants
Stephanie Dekom1, Avani Vachhani2, Krishan Patel2
1Division of Neonatology, Department of Pediatrics, LAC+USC Medical Center, Keck School of Medicine of USC, Los Angeles, CA, USA.
Insights
Higher initial hematocrit (Hct) in extremely low birth weight (ELBW) infants is linked to reduced peri/intraventricular hemorrhage (P/IVH). An initial Hct below 45% nearly doubles the risk of P/IVH in these vulnerable newborns.
Area of Science:
- Neonatal Physiology and Pathophysiology
- Perinatal Medicine
- Pediatric Neurology
Background:
- Peri/intraventricular hemorrhage (P/IVH) is a significant concern in extremely low birth weight (ELBW) infants.
- Ischemia-reperfusion injury is a key factor in P/IVH development.
- Delayed cord clamping has shown promise in reducing P/IVH by promoting placental transfusion.
Purpose of the Study:
- To investigate the association between initial hematocrit (Hct) levels and the incidence of P/IVH in ELBW infants.
- To determine if higher initial Hct correlates with a lower likelihood of developing P/IVH.
Main Methods:
- Retrospective review of pre- and postnatal data for inborn ELBW infants over a 7-year period.
- Logistic regression modeling was employed to analyze the relationship between initial Hct and P/IVH within the first week of life.
- Adjustments were made for gestational age and cesarean section delivery.
Main Results:
- Forty-one percent of the 225 studied ELBW infants experienced grade I-IV P/IVH.
- Higher gestational age, cesarean section, and initial Hct were associated with a decreased likelihood of P/IVH.
- An initial Hct below 40% (OR 2.04) and below 45% (OR 2.38) significantly increased the odds of P/IVH, even after adjusting for gestational age and cesarean section.
Conclusions:
- Elevated initial hematocrit levels in ELBW infants are associated with a reduced risk of P/IVH.
- Initial Hct below 45% was linked to a twofold increase in P/IVH risk.
- The findings suggest that lower initial Hct may indicate reduced intravascular volume, potentially leading to cerebral hypoperfusion and subsequent P/IVH.
Objective:
Ischemia followed by reperfusion plays a significant role in the pathogenesis of peri/intraventricular hemorrhage (P/IVH). Delayed cord clamping promotes placental transfusion to newborn and is associated with decreased P/IVH. We hypothesized that extremely low birth weight (ELBW) infants with higher initial hematocrit (Hct) after birth are less likely to develop P/IVH.
Study Design:
Pre- and postnatal data on inborn ELBW infants over 7 years were reviewed. We examined the relationship between P/IVH in the first week and initial Hct using logistic regression modeling.
Results:
We studied 225 infants with a median gestational age (GA) 25.7 (22.4-31.7). Forty-one percent had grade I-IV P/IVH. In univariate analysis, cesarean section (CS) and higher GA, birth weight, 5-minute Apgar, and initial Hct were associated with decreased likelihood of P/IVH while higher maximum PCO2 in first 3 days and use of inotropes/vasopressors, postnatal steroid for hypotension, hypernatremia, transfusion, and use of insulin for hyperglycemia during the first week of life were associated with increased likelihood of P/IVH. In multiple regression analysis, only GA, CS, and initial Hct remained significantly associated with P/IVH. Adjusting for GA and CS, the odds of P/IVH was higher with Hct < 40% (OR 2.04, 95% CI [1.11, 3.76]) and Hct < 45% (2.38 [1.19, 4.76]).
Conclusion:
Higher initial Hct is associated with decreased P/IVH. Initial Hct < 45% was associated with a 2-fold increase in P/IVH. We speculate that lower initial Hct represents a lower intravascular volume status and promotes cerebral hypoperfusion preceding P/IVH.
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