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Neonatal Hemoglobin Levels in Preterm Infants Are Associated with Early Neurological Functioning
Willemien S Kalteren1, Mirthe J Mebius1, Elise A Verhagen2
1Division of Neonatology, Department of Pediatrics, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Insights
Low hemoglobin in preterm infants is linked to poorer neurological outcomes. This is partly due to reduced cerebral oxygenation, impacting early brain development.
Area of Science:
- Neonatal neurology
- Pediatric hematology
- Neurodevelopmental outcomes
Background:
- Neonatal anemia can impair brain oxygen transport.
- The impact of anemia and cerebral oxygenation on early neurological function in neonates is not well understood.
Purpose of the Study:
- To investigate the association between initial hemoglobin levels and early neurological functioning in preterm infants.
- To assess general movements (GMs) as an indicator of neurological function.
Main Methods:
- Retrospective analysis of prospectively collected data from preterm infants (<32 weeks gestation).
- Exclusion of infants with severe intraventricular hemorrhage (grade > II).
- Assessment of general movements (GMs) and the general movement optimality score (GMOS) on day 8; measurement of cerebral tissue oxygen saturation (rcSO2) on day 1 via near-infrared spectroscopy.
Main Results:
- Lower day 1 hemoglobin (Hb) was associated with increased risk of abnormal GMs and poorer GMOS.
- Hb strongly correlated with cerebral oxygenation (rcSO2).
- Reduced rcSO2 was linked to a higher risk of abnormal GMs; Hb and rcSO2 explained significant variance in neurological functioning.
Conclusions:
- Low day 1 hemoglobin in preterm infants is associated with impaired neurological functioning at day 8.
- Reduced cerebral oxygenation partially mediates the negative effects of anemia on neurological outcomes.
Background:
Neonatal anemia may compromise oxygen transport to the brain. The effects of anemia and cerebral oxygenation on neurological functioning in the early neonatal period are largely unknown.
Objective:
This study aimed to determine the association between initial hemoglobin levels (Hb) and early neurological functioning in preterm infants by assessing their general movements (GMs).
Methods:
A retrospective analysis of prospectively collected data on preterm infants born before 32 weeks of gestation was conducted. We excluded infants with intraventricular hemorrhage > grade II. On day 8, we assessed infants' GMs, both generally as normal/abnormal and in detail using the general movement optimality score (GMOS). We measured cerebral tissue oxygen saturation (rcSO2) on day 1 using near-infrared spectroscopy.
Results:
We included 65 infants (median gestational age 29.9 weeks [IQR 28.2-31.0]; median birth weight 1,180 g [IQR 930-1,400]). Median Hb on day 1 was 10.3 mmol/L (range 4.2-13.7). Lower Hb on day 1 was associated with a higher risk of abnormal GMs (OR = 2.3, 95% CI: 1.3-4.1) and poorer GMOSs (B = 0.9, 95% CI: 0.2-1.7). Hemoglobin strongly correlated with rcSO2 (rho = 0.62, p < 0.01). Infants with lower rcSO2 values tended to have a higher risk of abnormal GMs (p = 0.06). After adjusting for confounders, Hb on day 1 explained 44% of the variance of normal/abnormal GMs and rcSO2 explained 17%. Regarding the explained variance of the GMOS, this was 25% and 16%, respectively.
Conclusions:
In preterm infants, low Hb on day 1 is associated with impaired neurological functioning on day 8, which is partly explained by low cerebral oxygenation.
