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Association of low hemoglobin at birth and neurodevelopmental outcomes in preterm neonates ≤28 weeks' gestation: a
Mohamed Elkhouli1,2, Kamini Raghuram1,3, Thanna Elhanafy1,3
1Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
Insights
Low birth hemoglobin levels in extremely preterm infants did not impact neurodevelopmental outcomes among survivors. However, the composite outcome of death or neurodevelopmental impairment was higher in the low hemoglobin group.
Area of Science:
- Neonatal Medicine
- Neurodevelopmental Pediatrics
- Pediatric Hematology
Background:
- Extremely preterm infants (≤28 weeks gestational age) are at high risk for adverse neurodevelopmental outcomes.
- Hemoglobin levels at birth may influence neonatal health and long-term development in this vulnerable population.
Purpose of the Study:
- To investigate the association between initial hemoglobin levels (<120 g/L vs. ≥120 g/L) at birth and neurodevelopmental outcomes at 18-24 months corrected age (CA) in extremely preterm infants.
Main Methods:
- A cohort study included infants born ≤28 weeks gestational age between 2009 and 2018.
- Neurodevelopmental impairment (NDI) at 18-24 months CA was the primary outcome.
- Multivariable logistic regression analyzed the association between initial hemoglobin levels and NDI, considering survival.
Main Results:
- Among 2351 eligible neonates, 14.9% had initial hemoglobin <120 g/L. Of 2113 survivors, 1534 underwent follow-up.
- No statistically significant difference in neurodevelopmental outcomes was observed between infants with low (<120 g/L) versus adequate (≥120 g/L) hemoglobin levels at birth.
- The composite outcome of death or NDI was significantly higher in the low hemoglobin group.
Conclusions:
- Initial hemoglobin levels <120 g/L at birth were not associated with neurodevelopmental impairment at 18-24 months CA among survivors of extremely preterm infants (≤28 weeks GA).
- Further research may explore the impact of early hemoglobin on mortality and morbidity in this population.
Objective:
To compare neurodevelopmental outcomes at 18-24 months corrected age (CA) for preterm infants who had hemoglobin levels <120 g/l versus those with hemoglobin level ≥120 g/l at birth.
Methods:
We included infants of ≤28 weeks gestational age (GA) born between January 2009 and June 2018. The primary outcome was neurodevelopmental impairment (NDI) at 18-24 months. Multivariable logistic regression was applied to determine the association.
Results:
Of the 2351 eligible neonates, 351 (14.9%) had hemoglobin levels <120 g/L at birth. Of the 2113 surviving infants, 1534 (72.5%) underwent developmental follow-up at 18-24 months CA. There was no statistically significant difference in ND outcomes between the two groups. The composite outcome of death or NDI was significantly higher in the low hemoglobin group.
Conclusion:
In preterm infants ≤28 weeks GA, initial hemoglobin <120 g/L at birth was not associated with neurodevelopmental impairment at 18-24 months CA among survivors.
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