107:
three times a week until they reached 35 weeks gestational age. The use of r-EPO did not decrease the average number of transfusions in the infants born at less than 1000 g, or the percentage of infants in the 1000 to 1250 group. A multi-center
European trial studied early versus late r-EPO in 219 infants with birth weights between 500 and 999 g. An r-EPO close of 750 U/kg/week was given to infants in both the early (1–9 weeks) and late (4–10 weeks) groups. The two r-EPO groups were compared to a control group who did not receive r-EPO. Infants in all three groups received 3 to 9 mg/kg of enteral iron. These investigators reported a slight decrease in transfusion and donor exposures in the early r-EPO group (1–9 weeks): 13% early, 11% late and 4% control group. It is likely that only a carefully selected subpopulation of infants may benefit from its use. Contrary to what just said, Bain and Blackburn (2004) also state in another study the use of r-EPO does not appear to have a significant effect on reducing the numbers of early transfusions in most infants, but may be useful to reduce numbers of late transfusion in extremely low-birth-weight infants. A British task force to establish transfusion guidelines for neonates and young children and to help try to explain this confusion recently concluded that “the optimal dose, timing, and nutritional support required during EPO treatment has yet to be defined and currently the routine use of EPO in this patient population is not recommended as similar reduction in blood use can probably be achieved with appropriate transfusion protocols.”
94:
worsening of anemia by minimizing the amount of blood drawn from the infant (ie, anemia from phlebotomy). It is found that since blood loss attributable to laboratory testing is the primary cause of anemia among preterm infants during the first weeks of life, it would be useful to quantify blood loss attributable to phlebotomy overdraw (ie, blood collected in excess than what is strictly required for the requested lab tests). Lin and colleagues performed a study to see when and if phlebotomy overdraw was actually a significant problem. They recorded all of the data that could be of influence such as the test performed, the blood collection container used, the infants location (neonatal intensive care unit (NICU) and intermediate intensive care unit), the infant’s weight sampling and the phlebotomist’s level of experience, work shift, and clinical role. Infants were classified by weight into 3 groups: <1 kg, 1 to 2 kg, and >2 kg. The volume of blood removed was calculated by subtracting the weight of the empty collection container from that of the container filled with blood. They found that the mean volume of blood drawn for the 578 tests exceeded that requested by the hospital laboratory by 19.0% ± 1.8% per test. The main factors of overdraw was: collection in blood containers without fill-lines, lighter weight infants and critically ill infants being cared for in the NICU.
123:
decrease phlebotomy loss and lead to a reduction in the need for blood transfusions among critically ill premature neonates as these tests frequently require much less volume of blood to be collected from the patient. A study was done by Madan and colleagues to test this theory by conducting a retrospective chart review on all inborn infants <1000g admitted to the NICU that survived for 2 weeks of age during two separate 1 year time periods. Conventional bench top laboratory analysis during the first year was done using
Radiometer Blood Gas and Electrolyte Analyzer. Bedside blood gas analysis during the second year was performed using a point-of-care analyzer (iSTAT). An estimated blood loss in the two groups was determined based on the number of specific blood tests on individual infants. The study found that there was an estimated 30% reduction in the total volume of blood removed for the blood tests. This study concluded that there is modern technology that can be used to limit the amount of blood removed from these infants thereby reducing the need for blood product transfusions (or the number of transfusions) and r-EPO.
103:
using the same dose. They established that more frequent dosing of the same weekly amount of r-EPO generated a significant and continuous increase in Hb in VLBW infants. The infants that received five dosages had higher absolute reticulocyte counts (219,857 mm³) than those infants that received only two dosages (173,361 mm³). However, it was noted that the response to r-EPO typically takes up to two weeks. This study also showed responses between two dosage schedules (two times a week and five times a week). Infants were recruited for gestational age—age since conception—≤27 weeks and 28 to 30 weeks and then randomized into the two groups, each totaling 500 U/kg a week. Brown and Keith found that after two weeks of r-EPO administration, Hb counts had increased and leveled off; the infants who received r-EPO five times a week had significantly higher Hb counts. This was present at four weeks for all infants ≤30 weeks gestation and at 8 weeks for infants ≤27 weeks gestation.
76:(EPO) are major causative factors. Blood sampling done for laboratory testing can easily remove enough blood to produce anemia. Obladen, Sachsenweger and Stahnke (1987) studied 60 very low birth weight infants during the first 28 days of life. Infants were divided into 3 groups, group 1 (no ventilator support, 24 ml/kg blood loss), group 2(minor ventilated support, 60 ml/kg blood loss), and group 3(ventilated support for respiratory distress syndrome, 67 ml/kg blood loss). Infants were checked for clinical symptoms and laboratory signs of anemia 24 hours before and after the blood transfusion. The study found that groups 2 and 3 who had significant amount of blood loss, showed poor weight gain, pallor and distended abdomen. These reactions are the most frequent symptoms of anemia in very low birth weight infants.
80:
significant increased production of erythropoietin (EPO), but this response is diminished in premature infants. Dear, Gill, Newell, Richards and
Schwarz (2005) conducted a study to show that there is a weak negative correlation between EPO and Hb. The researchers recruited 39 preterm infants from 10 days of age or as soon as they could manage without respiratory support. They estimated total EPO and Hb weekly and 2 days after a blood transfusion. The study found that when Hb>10, EPO mean was 20.6 and when Hb≤10, EPO mean was 26.8. As Hb goes down, EPO goes up.
39:
122:
For extremely low birth weight infants, laboratory blood testing using bedside devices offers a unique opportunity to reduce blood transfusions. This practice has been referred to as point-of-care testing or POC. Use of POC tests to measure the most commonly ordered blood tests could significantly
106:
To date, studies of r-EPO use in premature infants have had mixed results. Ohls et al. examined the use of early r-EPO plus iron and found no short-term benefits in two groups of infants (172 infants less than 1000 g and 118 infants 1000–1250 g). All r-EPO treated infants received 400 U/g
102:
Recombinant EPO (r-EPO) may be given to premature infants to stimulate red blood cell production. Brown and Keith studied two groups of 40 very low birth weight (VLBW) infants to compare the erythropoietic response between two and five times a week dosages of recombinant human erythropoietin (r-EPO)
79:
During the first weeks of life, all infants experience a decline in circulating red blood cell (RBC) volume generally expressed as blood hemoglobin concentration (Hb). As anemia develops, there is even more of a significant reduction in the concentration of hemoglobin. Normally this stimulates a
93:
AOP is usually treated by blood transfusion but the indications for this are still unclear. Blood transfusions have both infectious and non-infectious risks associated with them. Also, blood transfusions are costly and may add to parental anxiety. The best treatment for AOP is prevention of
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Preterm infants are often anemic and typically experience heavy blood losses from frequent laboratory testing in the first few weeks of life. Although their anemia is multifactorial, repeated blood sampling and reduced erythropoiesis with extremely low serum levels of
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Lin, James C.; Strauss, Ronald G.; Kulhavy, Jeff C.; Johnson, Karen J.; Zimmerman, M. Bridget; Cress, Gretchen A.; Connolly, Natalie W.; Widness, John A. (2000-08-01). "Phlebotomy
Overdraw in the Neonatal Intensive Care Nursery".
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Madan, Ashima; Kumar, Rahi; Adams, Marian M; Benitz, William E; Geaghan, Sharon M; Widness, John A (2004-10-07). "Reduction in Red Blood Cell
Transfusions Using a Bedside Analyzer in Extremely Low Birth Weight Infants".
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Brown, Mark S.; Keith, Julian F. (1999-08-01). "Comparison
Between Two and Five Doses a Week of Recombinant Human Erythropoietin for Anemia of Prematurity: A Randomized Trial".
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Lin, James C.; Strauss, Ronald G.; Kulhavy, Jeff C.; Johnson, Karen J.; Zimmerman, M. Bridget; Cress, Gretchen A.; Connolly, Natalie W.; Widness, John A. (2000-08-01).
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New, H. V.; Stanworth, S. J.; Engelfriet, C. P.; Reesink, H. W.; McQuilten, Z. K.; Savoia, H. F.; Wood, E. M.; Olyntho, S.; Trigo, F. (2009). "Neonatal transfusions".
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Obladen, M.; Sachsenweger, M.; Stahnke, M. (1988). "Blood sampling in very low birth weight infants receiving different levels of intensive care".
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Messer, J.; Haddad, J.; Donato, L.; Astruc, D.; Matis, J. (1993). "Early treatment of premature infants with recombinant human erythropoietin".
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Schwarz, K. B.; Dear, P. R. F.; Gill, A. B.; Newell, S. J.; Richards, M. (2005). "Effects of
Transfusion in Anemia of Prematurity".
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Madan, Ashima; Kumar, Rahi; Adams, Marian M; Benitz, William E; Geaghan, Sharon M; Widness, John A (2004-10-07).
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Bishara N, Ohls RK (February 2009). "Current controversies in the management of the anemia of prematurity".
59:. AOP is a normochromic, normocytic hypoproliferative anemia. The primary mechanism of AOP is a decrease in
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Lopriore, Enrico (2019-06-25). "Updates in Red Blood Cell and
Platelet Transfusions in Preterm Neonates".
886:"Reduction in Red Blood Cell Transfusions Using a Bedside Analyzer in Extremely Low Birth Weight Infants"
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Bain, Annamarie; Blackburn, Susan (April 2004). "Issues in
Transfusing Preterm Infants in the NICU".
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Bishara, Nader (February 2009). "Current controversies in the management of anemia of prematurity".
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Bain, Annamarie; Blackburn, Susan (2004). "Issues in
Transfusing Preterm Infants in the NICU".
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159:"Pathophysiology of Anemia During the Neonatal Period, Including Anemia of Prematurity"
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Strauss, Ronald G. (1995). "Neonatal Anemia: Pathophysiology and Treatment".
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540:. Abingdon, Oxon ; New York: Routledge. pp. 164–187.
272:"Phlebotomy Overdraw in the Neonatal Intensive Care Nursery"
115:
Other strategies involve the reduction of blood loss during
674:(2). Ovid Technologies (Wolters Kluwer Health): 170–182.
458:(4). Springer Science and Business Media LLC: 399–404.
328:(1). Springer Science and Business Media LLC: 21–25.
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415:(2). American Academy of Pediatrics (AAP): e19.
703:The Journal of Perinatal & Neonatal Nursing
668:The Journal of Perinatal & Neonatal Nursing
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846:(S 02). Georg Thieme Verlag KG: S37–S40.
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55:affecting preterm infants with decreased
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63:(EPO), a red blood cell growth factor.
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133:List of circulatory system conditions
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1307:Infant respiratory distress syndrome
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1312:Transient tachypnea of the newborn
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1090:Twin-to-twin transfusion syndrome
571:Pediatric Hematology and Oncology
1608:Vertically transmitted infection
840:American Journal of Perinatology
766:10.1111/j.1423-0410.2008.01105.x
715:10.1097/00005237-200404000-00011
680:10.1097/00005237-200404000-00011
1700:Fetal Alcohol Spectrum Disorder
1650:Group B streptococcal infection
1218:Intrauterine growth restriction
538:Neonatal Intensive Care Nursing
1043:Conditions originating in the
452:European Journal of Pediatrics
138:List of hematologic conditions
1:
1392:Vitamin K deficiency bleeding
817:10.1053/j.semperi.2008.10.006
536:Boxwell, Glenys (2010). "8".
240:10.1053/j.semperi.2008.10.006
1551:Periventricular leukomalacia
1369:Persistent fetal circulation
1317:Meconium aspiration syndrome
495:Immunological Investigations
157:Widness JA (November 2008).
1460:Intraventricular hemorrhage
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1465:Germinal matrix hemorrhage
1455:Velamentous cord insertion
1346:Bronchopulmonary dysplasia
51:(AOP) refers to a form of
1495:Necrotizing enterocolitis
1204:Large for gestational age
1200:Small for gestational age
583:10.1080/08880010500198418
507:10.3109/08820139509062784
228:Seminars in Perinatology
1657:Neonatal conjunctivitis
1148:Single umbilical artery
1138:Umbilical cord prolapse
1085:Placental insufficiency
1058:complicating pregnancy,
890:Journal of Perinatology
322:Journal of Perinatology
207:"Anemia of prematurity"
1633:ureaplasma urealyticum
1341:Wilson–Mikity syndrome
1265:Brachial plexus injury
852:10.1055/s-0039-1691775
629:10.1542/peds.104.2.210
421:10.1542/peds.106.2.e19
289:10.1542/peds.106.2.e19
111:Transfusion management
1581:Congenital hypertonia
1472:Anemia of prematurity
1180:Shoulder presentation
903:10.1038/sj.jp.7211201
377:10.1542/peds.92.4.519
334:10.1038/sj.jp.7211201
175:10.1542/neo.9-11-e520
49:Anemia of prematurity
22:Anemia of prematurity
1586:Congenital hypotonia
1500:Meconium peritonitis
1302:Intrauterine hypoxia
1258:Subgaleal hemorrhage
1695:Neonatal withdrawal
1678:Perinatal mortality
1528:Sclerema neonatorum
1384:hematologic disease
1628:mycoplasma hominis
1613:Neonatal infection
1569:Gray baby syndrome
1546:Perinatal asphyxia
1436:Hyperbilirubinemia
1213:Postterm pregnancy
1060:labour or delivery
987:External resources
464:10.1007/bf00496419
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1253:Caput succedaneum
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547:978-0-415-47756-7
169:(11): e520–e525.
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1688:Infant mortality
1523:Erythema toxicum
1515:thermoregulation
1482:Gastrointestinal
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1049:fetal disease
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1329:Pneumothorax
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1235:
1228:Birth trauma
1170:Breech birth
1160:presentation
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1126:
1100:
1068:
994:
966:
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896:(1): 21–25.
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839:
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811:(1): 29–34.
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760:(1): 62–85.
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234:(1): 29–34.
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210:. Retrieved
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92:
78:
70:
48:
47:
1726:Neonatology
1673:Miscarriage
1575:muscle tone
1441:Kernicterus
1294:Respiratory
1270:Erb's palsy
1175:Asynclitism
1143:Nuchal cord
89:Transfusion
1715:Categories
1683:Stillbirth
1640:Omphalitis
1601:Infections
1510:Integument
617:Pediatrics
409:Pediatrics
365:Pediatrics
282:(2): e19.
276:Pediatrics
212:2010-05-31
163:NeoReviews
144:References
117:phlebotomy
57:hematocrit
33:Pediatrics
1409:Anti-Kell
1047:period /
1045:perinatal
996:eMedicine
912:0743-8346
860:0735-1631
774:1423-0410
723:0893-2190
688:0893-2190
637:0031-4005
591:0888-0018
556:434319115
515:0882-0139
472:0340-6199
429:1098-4275
385:0031-4005
342:0743-8346
298:0031-4005
84:Treatment
67:Mechanism
28:Specialty
1379:Bleeding
1070:placenta
920:15496875
868:31238357
825:19167579
790:41930858
782:19121200
739:21928067
731:15214254
653:24961879
645:10428996
599:16166047
437:10920175
350:15496875
306:10920175
248:19167579
193:20463861
127:See also
1721:Anemias
1618:rubella
1248:Chignon
1102:chorion
523:7713595
480:3396595
393:8414820
184:2867612
1193:Growth
1106:amnion
918:
910:
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858:
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246:
191:
181:
53:anemia
35:
1666:Other
1490:Ileus
1237:scalp
977:776.6
962:P61.2
786:S2CID
735:S2CID
649:S2CID
1424:Rh E
1419:Rh D
1414:Rh c
972:9-CM
916:PMID
908:ISSN
864:PMID
856:ISSN
821:PMID
778:PMID
770:ISSN
727:PMID
719:ISSN
684:ISSN
641:PMID
633:ISSN
595:PMID
587:ISSN
552:OCLC
542:ISBN
519:PMID
511:ISSN
476:PMID
468:ISSN
433:PMID
425:ISSN
389:PMID
381:ISSN
346:PMID
338:ISSN
302:PMID
294:ISSN
244:PMID
189:PMID
1512:and
1404:ABO
1399:HDN
1381:and
968:ICD
953:ICD
898:doi
848:doi
813:doi
762:doi
711:doi
676:doi
625:doi
621:104
579:doi
503:doi
460:doi
456:147
417:doi
413:106
373:doi
330:doi
284:doi
280:106
236:doi
179:PMC
171:doi
98:EPO
1717::
1211:/
1202:/
999::
975::
960::
957:10
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906:.
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876:^
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607:^
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256:^
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1036:e
1029:t
1022:v
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955:-
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167:9
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