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Changes in Fetal Hemoglobin in Very Preterm Infants Born Small for Gestational Age: A Retrospective Observational

Carlo Dani1,2, Federico Cipriani2, Maria Ciavotta2

  • 1Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, 50127 Florence, Italy.

Children (Basel, Switzerland)
|January 28, 2026
PubMed

Insights

Hemoglobin F (HbF) levels decreased similarly in both small-for-gestational-age (SGA) and appropriate-for-gestational-age (AGA) preterm infants. Red blood cell transfusions did not impact HbF in SGA infants but lowered it in AGA infants, possibly due to fetal hypoxia.

Area of Science:

  • Neonatology
  • Perinatal Medicine
  • Hematology

Background:

  • Small-for-gestational-age (SGA) preterm infants face increased oxidative stress risks compared to appropriate-for-gestational-age (AGA) infants.
  • Elevated fetal hemoglobin (HbF) in SGA infants is hypothesized due to fetal hypoxia.
  • Understanding HbF dynamics is crucial for managing preterm infant complications.

Purpose of the Study:

  • To compare postnatal changes in HbF fractions between very preterm SGA and AGA infants.
  • To analyze HbF fraction changes in transfused versus non-transfused subgroups.
  • To investigate the potential role of fetal hypoxia in observed HbF patterns.

Main Methods:

  • Study included 30 SGA and 60 AGA very preterm infants (gestational age ~28 weeks).
  • HbF fractions were measured daily in the first week, then at 14, 21, 28 days, and 36 weeks postmenstrual age.
  • Infants were analyzed in subgroups based on red blood cell (RBC) transfusion status.

Main Results:

  • HbF fractions significantly decreased throughout the postnatal period in both SGA and AGA groups, with no inter-group differences.
  • SGA infants, whether transfused or not, showed similar HbF values.
  • Transfused AGA infants exhibited lower HbF fractions compared to non-transfused AGA infants.

Conclusions:

  • Postnatal HbF fraction decline is comparable in very preterm SGA and AGA infants.
  • RBC transfusions did not alter HbF in SGA infants but reduced it in AGA infants.
  • Observed differences in transfused AGA infants may relate to fetal preconditioning hypoxia in SGA infants.

Keywords:
fetal hemoglobinintra uterine growth restrictionpreterm infantsmall for gestational age

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