Hemodynamic adaptation in neonates with early-onset severe anemia during transition period

To characterize hemodynamics in the first 24 h after birth in neonates with severe anemia.

This was a retrospective analysis of data from a prospective cohort from our critically ill neonate database, that included neonates with severe anemia from December 2022 to June 2024. The results obtained from neonates with severe anemia and the control group were compared.

A total of 21 neonates born at 37 [35.00, 38.00] weeks and weighing 2780 [2350, 3200] grams were included. Compared with the control group, we observed lower peak systolic myocardial velocity in biventricular (left: 5.67 [5.43, 6.48] vs. 6.6 [6.12, 7.32], p < 0.001; right: 6.33 [5.72, 7.48] vs. 8.02 [6.74, 8.86], p < 0.001). A greater ratio of the tricuspid valve early inflow velocity/early diastolic myocardial velocity was noted (6.63 [5.92, 9.27] vs. 5.31 [4.67, 6.55], p < 0.001). The peak systolic blood flow of middle cerebral arteries was greater (left: 55.90 [47.10, 64.90] vs. 44.95 [38.20, 50.95], p = 0.008; right: 52.00 [40.88, 56.15] vs. 45.20 [38.00, 52.00], p = 0.048). The lung ultrasound score was 18.00 [13.5, 25.5].

Neonates with severe anemia are characterized by reduced cardiac systolic function, reduced right diastolic function, increased cerebral blood flow, and pulmonary edema during the transition period.

The study was registered in Chinese Clinical Trial Registry (ChiCTR2200065581; https://www.chictr.org.cn/com/25/showproj.aspx?proj=184095 ).

This study explored hemodynamic characteristics, including cardiac function, blood flow in middle cerebral arteries, and the lung air/fluid ratio, in neonates with early-onset severe anemia and emphasized impaired cardiac systolic and diastolic function and a hypervolemic state in the pulmonary system and brain during the transition period. These hemodynamic changes are more related to the duration of severe anemia than to the severity of anemia. Given the hemodynamic changes in neonates with severe anemia, volume expansion and transfusion should be optimized.