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Fetal haemoglobin and oxygen requirement in preterm infants: an observational study

Tommy Ulinder1,2, William Hellström3, Christian Gadsbøll4

  • 1Department of Clinical Sciences Lund, Paediatrics, Lund University, Lund, Sweden tommy.ulinder@med.lu.se.

Archives of Disease in Childhood. Fetal and Neonatal Edition
|September 25, 2024
PubMed

Insights

Lower fetal hemoglobin (HbF) levels in preterm infants correlate with higher oxygen needs, indicated by increased fraction of inspired oxygen (FiO2) and alveolar-arterial gradient (A-a gradient). This suggests a potential link to bronchopulmonary dysplasia (BPD).

Area of Science:

  • Neonatal Medicine
  • Respiratory Physiology
  • Pediatric Cardiology

Background:

  • Bronchopulmonary dysplasia (BPD) is a significant complication in very preterm infants.
  • Fetal hemoglobin (HbF) plays a crucial role in oxygen transport in utero.
  • Reduced HbF levels have been anecdotally linked to BPD development.

Purpose of the Study:

  • To investigate the relationship between fetal hemoglobin fraction (HbF(%)) and oxygen requirements in very preterm infants.
  • To determine if HbF levels correlate with the fraction of inspired oxygen (FiO2) and alveolar-arterial gradient (A-a gradient).
  • To explore the potential role of increased oxygen exposure in the association between decreased HbF and BPD.

Main Methods:

  • A longitudinal, retrospective, observational study was conducted.
  • Data from 440 very preterm infants (born before 30 weeks gestation) were analyzed.
  • Fraction of inspired oxygen (FiO2) and alveolar-arterial gradient (A-a gradient) were measured using arterial blood gas analyses during the first postnatal week.

Main Results:

  • A significant inverse relationship was found between HbF(%) and both FiO2 and A-a gradient.
  • These associations remained statistically significant after adjusting for factors like gestational age, postnatal age, pH, pCO2, and sex.
  • Lower HbF levels were associated with increased oxygen requirements in the early neonatal period.

Conclusions:

  • Decreased HbF(%) in the first postnatal week is significantly associated with higher oxygen requirements (increased FiO2 and A-a gradient) in very preterm infants.
  • Increased alveolar oxygen exposure, potentially driven by lower HbF, may contribute to oxidative stress.
  • This oxidative stress could partially explain the link between reduced HbF, blood transfusions, and the development of BPD in preterm infants.
Abstract

Keywords:
Intensive Care Units, NeonatalNeonatologyPaediatrics

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